Application of Posterior Endoscopic Cervical Foraminotomy for Recurrent Radiculopathy After Anterior Cervical Discectomy and Fusion Surgery

Abstract

Objective: Anterior cervical discectomy and fusion (ACDF) surgery is a standard treatment for cervical spondylotic myelopathy or radiculopathy. Although the outcomes of ACDF are quite satisfactory, recurrent radiculopathy due to restenosis or adjacent degeneration cannot be completely avoided. We applied posterior endoscopic cervical foraminotomy (PECF) as salvage surgery after ACDF in 11 patients (16 levels). Methods: We performed PECF in 11 patients (16 levels) in the past 5 years for recurrent radiculopathy after ACDF. The time until the development of recurrent radiculopathy ranged from 8 months to 3 years. Before surgery, all patients were treated with adequate medication and rehabilitation. The radiological tools used for the evaluation included x-ray examinations (with anteroposterior, lateral, flexion, extension, and bilateral oblique views), computed tomography, and magnetic resonance imaging of the cervical spine.Results: Only one of the 11 patients did not respond immediately; however, that patient showed gradual recovery after decompression surgery in the following 6 months. Another patient showed good sensory function recovery, but transient motor palsy for 2 weeks. Otherwise, all the other patients showed motor or sensory function recovery, without symptom deterioration. None of these patients presented instability or mechanical pain after surgery or required repeat anterior surgery during follow-up (8 to 20 months; mean, 12 months).Conclusion: PECF, a minimally invasive posterior cervical surgical procedure, is efficient and effective as salvage surgery for restenosis after ACDF. This procedure prevents scarring along the trajectory and the need for longer fusion.