Prospective Study of Microsurgical Anterior Foramenotomy for Cervical Radiculopathy

Purpose:

To report a series of cases of microsurgical anterior foramenotomy (MAF) for acute cervical radiculopathy secondary to disc herniation or spondylosis.

Methods:

Prospective observational study of acute cervical radiculopathy (not myelopathy) from posterolateral herniated disc or spondylosis, all treated with MAF. Patients were examined in routine follow–up and with yearly phone calls or examinations. Outcome was measured with a simple outcome scale. Results: Thirty–six patients underwent 38 foramenotomies. Follow–up ranged from 13 weeks to 3.2 years (mean 1.6 years). Outcomes were excellent in 21, fair in 11 and poor in four. No patients had post–operative symptoms resulting in inability to perform ADLs or work full time. Complications included vertebral artery injury in one (early in series), Horner's syndrome in three (permanent in one) and mild dysphagia in one. In addition, four patients developed aseptic discitis o the involved disc treated with repeat operation by anterior cervical discectomy and fusion (ACDF) in two. One other patient had recurrent herniation treated with delayed ACDF. Of 23 patients presenting with acute herniation, 19 had excellent and four had fair outcome, two developed aseptic discitis and one had recurrent herniation. Of 1 3 patients presenting with spondylosis, two had excellent, seven had fair and four had poor outcome. Two developed aseptic discitis.

Discussion/Conclusion:

MAF is a safe and effective operation for the treatment of cervical radiculopathy, especially acute cervical disc herniation. MAF is an outpatient operation without fusion, bone grafting or plating, and without need for cervical immobilization or significant post–operative restrictions.