Keyhole Approach for Posterior Cervical Discectomy: Experience on 84 Patients

Abstract

Anterior cervical discectomy with or without fusion has been commonly used for cervical disc disease since the description by Smith and Robinson in 1958. In this report, surgical technique, advantages, and disadvantages of the posterior approach, known as the posterior keyhole laminotomy-foraminotomy, are reviewed and motion versus fusion surgery discussed. Between 1996 and 2004, the keyhole laminotomy-foraminotomy was performed on 84 patients suffering from lateral cervical soft disc herniation or osteophytes. All the procedures were performed under the surgical microscope. A high-speed drill was used for drilling the bone. In 49 patients (58%), soft disc herniation was removed, while in 35 patients (42%) there were osteophytes. Successful relief of radiculopathy symptoms was achieved in 80 patients (96%). In 4 patients the symptoms recurred. One patient (1.2%) developed kyphosis. The only complication observed intraoperatively was a partial root injury in one patient (1.2%). Mean hospitalization time was 48 hours. The posterior approach is particularly appropriate in patients whose root compression is located posterolaterally. Advantages of this surgery are minimal lamina resection, good visualization of the nerve root, postoperative early mobilization and minimal hospitalization. Microsurgery enables us to both preserve the motion of operated segment and avoid cervical instability.

Key words

Cervical radiculopathy - disc herniation - keyhole - anatomy

References

• 1 Smith GW, Robinson RA. The treatment of certain cervical-spine disorders by anterior removal of intervertebral disc and interbody fusion.  J Bone Joint Surg [Am]. 1958;  40 607-624
• 2 Yasargil MG. Cervical Disc Herniation. In: Yasargil MG (ed). Microsurgery Applied to Neurosurgery. Georg Thieme Verlag, Stuttgart 1969 pp 177-179
• 3 McCulloch JA, Young PH. Posterior microlaminotomy-facetotomy for foraminal soft discs and spurs. In: McCulloch JA, Young PH (eds). Essentials of Spinal Microsurgery. Lippincott-Raven Publishers 1998 pp 187-194
• 4 Aldrich F. Posterolateral microdiscectomy for cervical monoradiculopathy caused by posterolateral soft cervical disc sequestration.  J Neurosurg. 1990;  72 370-377
• 5 Ball AP. Management of cervical disc disease: Posterior Approach. In: Menezes AH, Sonntag VKH (eds). Mc Graw-Hill 1996 pp 539-546
• 6 Zeidman SM, Ducker TB. Posterior cervical laminoforaminotomy for radiculopathy: review of 172 cases.  Neurosurgery. 1993;  33 356-362
• 7 Epstein JA, Lavine LS, Aronson HA, Epstein BS. Cervical spondylotic radiculopathy: the syndrome of foraminal constriction treated by foraminotomy and the removal of osteophytes.  Clin Orthop Relat Res. 1965;  40 113-122
• 8 Scoville WB. Cervical disc classifications, indication and approaches with special reference to posterior keyhole operation. In: Dunsker (ed) Cervical spondylosis. New York, Raven Press 1981 pp 155-167
• 9 Witzmann A, Hejazi N, Krasznai L. Posterior cervical foraminotomy. A follow-up study of 67 surgically treated patients with compressive radiculopathy.  Neurosurg Rev. 2000;  23 213-217
• 10 Takayama S, Kuribayashi K, Miyamoto Y, Nakasu Y, Handa J. Ossification and calcification of the cervical ligamentum flavum case reports.  No To Shinkei. 1993;  45 859-563
• 11 Chen BH, Natarajan RN, An HS, Anderson GB. Comparison of biomechanical response to surgical procedures used for cervical radiculopathy: posterior keyhole foraminotomy versus anterior foraminotomy and discectomy versus anterior discectomy with fusion.  J Spinal Disord. 2001;  14 17-20
• 12 Fager CA. Posterolateral approach to the ruptured median and paramedian cervical disc.  Surg Neurol. 1983;  20 443-452
• 13 Henderson CM, Hennessey RG, Shuey HM, Shackelford EG. Posterior-lateral foraminotomy as an exclusive operatively technique for cervical radiculopathy: a review of 846 consecutive operated cases.  Neurosurgery. 1983;  13 504-512
• 14 Epstein NE. A review of laminoforaminotomy for the management of lateral and foraminal cervical herniations and spurs.  Surg Neurol. 2002;  57 226-234
• 15 Ebraheim NA, Xu R, Bhatti RA, Yeasting RA. The projection of the cervical disc and uncinate process on the posterior aspect of the cervical spine.  Surg Neurol. 1999;  51 363-367
• 16 Raynor RB, Pugh J, Shapiro I. Cervical facetectomy and its effect on spine strength.  J Neurosurg. 1985;  63 278-282
• 17 Ugur HC, Attar A, Uz A, Egemen N, Caglar YS, Genc Y. Surgical anatomic evaluation of the cervical pedicle and adjacent neural structures.  Neurosurgery. 2000;  47 1162-1168 , discussion 1168-1169
• 18 Perneczky A, Sunder-Plassmann M. Intradural variant of cervical nerve root fibres. Potential cause of misinterpreting the segmental location of cervical disc prolapses from clinical evidence.  Acta Neurochir (Wien). 1980;  52 79-83
• 19 Fessler RG, Khoo LT. Minimally invasive cervical microendoscopic foraminotomy: an initial clinical experience.  Neurosurgery. 2002;  51 ((Suppl 5)) S37-45
• 20 Lam S, Khoo LT, Cannestra A, Holly L, Shamie AN, Wang J, Fessler RG. A long-term clinical outcome analysis of minimally invasive cervical foraminotomy for the treatment of cervical radiculopathy.  Eur Spine J. 2005;  14 ((Suppl 1)) S2

Correspondence