Abstract
Introduction
Cervicobrachialgia because of the foraminal disc herniation in most of the cases have reacted positively to medical treatment. In those cases in which surgery is indicated, the surgical approach can vary significantly. Fusion surgery by anterior approach has become the chosen treatment for this kind of pathology, but in cases of cervical disc herniation with foraminal compression of the emerging root, a cervical posterior foraminotomy (CPF) is recommended. Although CPF is an effective and minimally invasive procedure, retraction of the root and the epidural venous bleeding can be an obstacle for the discectomy. Sometimes, it may be impossible to remove the fragments of herniated discs. This difficulty is commonly cited by surgeons performing this procedure. We conducted a retrospective review of cases with foraminal cervical disc herniation treated with CPF with and without discectomy. In this study, we aim to compare the CPF with and without discectomy for the treatment of radicular pain caused by a herniated cervical foraminal disc.
Patients and Methods
From November 2008 to March 2014, we performed CPF in 35 patients with foraminal cervical disc herniations. All patients had cervicobrachialgia as primary symptom and had not responded to more than 6 weeks of conservative treatment. We included patients only with foraminal disc herniation in one level. In 25 patients with CPF, discectomy was performed. In the remaining 10 patients, discectomy was unable to be performed. Functional outcomes were measured with the Analog Pain Scale (VAS), the Neck Disability Index (NDI) at the preoperative, immediate postoperative, and follow-up. The ODOM Criteria was employed at the last control. In the preoperative assessment, plain radiographs, CT, and MRI of all patients were included.
Results
The secondary radicular pain of foraminal cervical disc herniation was the predominant symptom and pathology. Discectomy was performed in 25 of the 35 who underwent surgery. The most affected level was C5–C6 in both the groups. The average preoperative VAS was 8.8 with a marked improvement in all the cases. The average at the postoperative control was 0.4 in the cases in which discectomy was performed, whereas, in those cases with no discectomy, it was 0.3. The average of the Neck Disability Index at baseline was 35.3 with a positive performance in the final evaluation (0.6) for both the groups. Odom Criteria was satisfactory with an average 1.17 for the discectomy, and 1 for the other group. There were no infections, discitis, or worsening of preexisting symptoms in any patient. We observed dysesthesias in one patient at C6 level and distal paresthesias in other. Both patients belonged to the discectomy group. Symptoms improved after 4 months of surgery.
Conclusion
The CPF with or without discectomy is an effective procedure for the treatment of cervical foraminal herniated disc. No significant differences were observed in both the groups, but the removal of the herniated disc could have produced symptoms postoperatively as we observed in two patients. In spite of the fact that we have had a limited number of patients treated with this procedure so far, we can state that overall the outcomes of the treatment performed were highly satisfactory and no complications were observed.