Surgical design and clinical application of posterior percutaneous full-endoscopic cervical foraminotomy for cervical osseous foraminal stenosis / 中国修复重建外科杂志

ABSTRACT

Objective: To design the method of posterior percutaneous full-endoscopic cervical foraminotomy (P-PECF) for treating cervical osseous foraminal stenosis and analyze its feasibility in clinical application. Methods: The clinical data of 12 patients with cervical osseous foraminal stenosis who met the selection criteria between October 2015 and June 2017 were retrospectively analysed. There were 7 males and 5 females with an age of 52-63 years (mean, 57.6 years). The disease duration ranged from 15 days to 6 months (mean, 3.7 months). The segments included C 4, 5 in 2 cases, C 5, 6 in 6 cases, and C 6, 7 in 4 cases; all showing root pain or numbness caused by nerve root compression. All patients were treated with the P-PECF technique. At preoperation, immediately after operation, and at last follow-up, visual analogue scale (VAS) scores and neck disability index (NDI) were respectively recorded to assess the patient's quality of life and the pain of neck and arm. The clinical outcomes were evaluated by the modified Macnab criteria. Results: All operations were successful. The operation time was 71-105 minutes (mean, 82 minutes); the intraoperative blood loss was about 5 mL. The CT of the cervical spine at 1 week postoperatively showed that the cervical root canal was enlarged and the nerve root compression was relieved. The symptoms of neck and arm pain and numbness were relieved; the hospitalization time was 2-5 days (mean, 3 days). All patients were followed up 6-18 months (mean, 12.3 months). Except for 1 patient's feeling transient hypoesthesia postoperatively, there was no complication such as hematoma, nerve root injury, or incision infection. The VAS scores and NDI at immediate postoperatively and at last follow-up were significantly improved when compared with preoperative scores ( P<0.05); and the scores also improved significantly at last follow-up when compared with the scores at immediate postoperatively ( P<0.05). According to modified Macnab criteria, the results were excellent in 9 cases, good in 2 cases, and fair in 1 case, with an excellent and good rate of 91.7%. Conclusion: The P-PECF technique can enlarge the nerve root canal and relieve nerve root compression, and obtain better effectiveness by minimally invasive methods. It is a safe and feasible procedure.