MICROSURGICAL CERVICAL NERVE ROOT DECOMPRESSION VIA AN ANTEROLATERAL APPROACH

Abstract

Abstract OBJECTIVE We previously reported our technique of selective microforaminotomy via an anterolateral approach for the treatment of spondylotic radiculopathy. We now report the clinical long-term results. METHODS A retrospective study of 40 patients who consecutively underwent operation via this technique was performed. Patients' demographic, clinical presentation, and radiological and surgical data were recorded by chart review. Long-term clinical outcome was assessed by a questionnaire, office visits, and intensive telephone interviews. The results were compared with the literature. RESULTS The study was comprised of 22 women and 18 men with a mean age of 50.6 years (age range, 33.1–75.2 yr). Preoperatively, 98% (n = 39) of the patients presented radicular pain, 88% (n = 35) of the patients presented with neck pain, 75% (n = 30) of the patients presented with a sensory deficit, and 45% (n = 18) of the patients presented with a motor deficit. Patients underwent operation at one level (n = 15), two levels (n = 23), or three levels (n = 2). One patient underwent operation bilaterally in a two-step procedure. In total, 68 cervical nerve roots were completely decompressed by this technique. On the basis of preoperative x-ray criteria of instability, two patients (5%) required graft arthrodesis, which was performed during the same surgery after the nerve root decompression. After a mean follow-up period of 4.3 years (range, 2.7–7.4 yr), 85% of the patients have no residual radicular pain, 94% of the patients have no more neck pain, 90% of the patients recovered from their sensory deficits, and 83% of the patients recovered from their motor deficits. According to Odom's criteria, 95% achieved an excellent or good outcome (Odom Grades I and II). No postoperative instability occurred. The transient and permanent morbidity rates were 7.5% (n = 3) and 2.5% (n = 1), respectively; one patient has permanent Horner's syndrome. CONCLUSION The technique of microsurgical cervical nerve root decompression by selective microforaminotomy via an anterolateral approach is safe and efficient for the treatment of spondylotic radiculopathy. The morbidity rate is low. Clinical results are good after a long-term follow-up period. This technique allows the preservation of cervical motion and spinal stability. The results compare favorably to those of the literature.