Peto Ivo, Scheiwe Christian, Kogias Evangelos, Hubbe Ulrich
Department of Neurosurgery, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Clin Spine Surg. 2017 Dec;30(10):E1419-E1425. doi: 10.1097/BSD.0000000000000517.
Retrospective cohort study.
Assessment of outcome after minimally invasive posterior cervical foraminotomy (MI-PCF).
Surgical management of cervical radiculopathy represents a controversial area in spinal surgery. Preferred approaches include both anterior cervical discectomy and posterior cervical foraminotomy (PCF). Numerous studies showed comparable results. Employing PCF eliminates risks associated with anterior approach. PCF as originally described by Spurling and Scoville necessitates extensive stripping of cervical muscles to expose the cervical spine, resulting in muscle injury, impaired muscle function, prolonged postoperative neck pain, and increased use of narcotics. There are only few studies investigating outcome after employing MI-PCF.
Retrospective review of 34 patients who underwent MI-PCF for presenting complaints, postoperative and follow-up outcome.
In the last follow-up the weakness resolved completely in 62.6% of patients, in 4.1% improved and in 16.5% remained unchanged. In the last follow-up 76.7% of patients originally presenting with pain reported complete resolution of pain and 10% reported partial improvement of pain. In total, 23.5% of patients were lost during follow-up as far as pain was concerned. In the last follow-up, 75% of patients achieved relative neck-pain-freedom (Visual Analog Scale≤3) at rest and 62.5% of patients under strain. The mean neck pain on Visual Analog Scale at rest was 2.13 (SD=2.42) and 3.34 (SD=3.01) under strain. In total, 93.8% (n=15) of patients would undergo the same procedure for the same achieved result.
Minimally invasive cervical foraminotomy is an effective procedure for decompression of cervical nerve roots regardless the type of the stenosis. Even employing minimally invasive technique still causes neck pain in the long term affecting up to 25% of patients. More randomized control studies are required to clarify the benefits of minimally invasive PCF.
回顾性队列研究。
评估微创后路颈椎椎间孔切开术（MI - PCF）后的疗效。
颈椎神经根病的手术治疗是脊柱外科中一个有争议的领域。首选的手术方法包括颈椎前路椎间盘切除术和后路颈椎椎间孔切开术（PCF）。大量研究显示结果相当。采用PCF可消除前路手术相关的风险。最初由斯珀林（Spurling）和斯科维尔（Scoville）描述的PCF需要广泛剥离颈部肌肉以暴露颈椎，导致肌肉损伤、肌肉功能受损、术后颈部疼痛延长以及麻醉剂使用增加。仅有少数研究调查了采用MI - PCF后的疗效。
回顾性分析34例因出现相关症状而接受MI - PCF手术的患者的术后及随访结果。
在最后一次随访时，62.6%的患者肌无力完全缓解，4.1%有所改善，16.5%无变化。在最后一次随访时，最初有疼痛症状的患者中，76.7%报告疼痛完全缓解，10%报告疼痛部分改善。总体而言，就疼痛而言，23.5%的患者在随访期间失访。在最后一次随访时，75%的患者在休息时达到相对无痛（视觉模拟评分≤3），62.5%的患者在用力时达到相对无痛。休息时视觉模拟评分的平均颈部疼痛为2.13（标准差 = 2.42），用力时为3.34（标准差 = 3.01）。总体而言，93.8%（n = 15）的患者会因相同的手术效果而接受相同的手术。
无论狭窄类型如何，微创颈椎椎间孔切开术都是一种有效的颈椎神经根减压手术。即使采用微创技术，长期来看仍有多达25%的患者会出现颈部疼痛。需要更多的随机对照研究来阐明微创PCF的益处。
