Posterior Cervical Microscopic Foraminotomy and Discectomy with Laser for Unilateral Radiculopathy

Abstract

Surgical decompression for cervical radiculopathy includes anterior cervical discectomy and fusion, anterior or posterior cervical foraminotomy, and cervical arthroplasty after decompression. The aim of this study was to evaluate the usefulness of a CO2 laser in posterior-approach surgery for unilateral cervical radiculopathy. From January 2006 to December 2008, 12 consecutive patients with unilateral cervical radiculopathy from either foraminal stenosis or disc herniation, which was confirmed with imaging studies, underwent posterior foraminotomy and discectomy with the use of a microscope and CO2 laser. For annulotomy and discectomy, we used about 300 joules of CO2 laser energy. Magnetic resonance imaging (MRI) was used to evaluate the extent of disc removal or foraminal decompression. Clinical outcome was evaluated by using visual analogue scale scores for radicular pain and Odom's criteria. For evaluation of spinal stability, cervical flexion and extension radiographs were obtained. Single-level foraminotomy was performed in 10 patients and two-level foraminotomies were performed in 2 patients. Preoperative radicular symptoms were improved immediately after surgery in all patients. No surgery-related complications developed in our cases. Postoperative MRI demonstrated effective decompression of ventral lesions and widened foraminal spaces in all cases. There was no development of cervical instability during the follow-up period. Posterior foraminotomy and discectomy using a microscope and CO2 laser is an effective surgical tool for unilateral cervical radiculopathy caused by lateral or foraminal disc herniations or spondylotic stenosis. Long-term follow-up with radiographs showed no significant kyphotic changes or spinal instability.

Keywords: Discectomy; Foraminotomy; Lasers; Radiculopathy.

FIG. 1. The clinical outcome according to the Odom's criteria. X: time on F/U, Y: number of patient.

FIG. 2. A patient with a C6-7 foraminal stenosis and disc herniation on the left side (patient 5); preoperative T2-weighted magnetic resonance imaging (MRI) showing left foraminal stenosis with disc herniation on the C6-7 (A and B), postoperative MRI showing the state of left unilateral foraminal decompression with disc removal (C and D).

FIG. 3. Intraoperative microscopic view (patient 5); the state after foraminotomy (A), and the state after laser discectomy (B). C: central spinal cord, R: root, and D: protruding disc.