Cervical Radiculopathy Treated Surgically on an Outpatient Basis
Since the original article1 was published, outpatient treatment for cervical disc disease has become our routine. I would estimate that as high as 95% of our cervical radiculopathies can be treated as an outpatient. We have yet to have a serious complication.
We believe that treatment of cervical radiculopathy by the posterior approach is much superior to the anterior discectomy and fusion technique in most cases. Reasons for this include the fact that a laminectomy does not create temporary instability and therefore a cervical collar or brace is not necessary. In other words, a patient can drive a car a few days postoperative. A scar in front of the throat is avoided. We have found that a fusion results in extra wear and tear on the joints above and below the fusion resulting in the need for additional surgery years later. Also, the cost of a cervical fusion is usually double that of a laminectomy. In cases of the rarely indicated multiple level procedure utilizing screws and plates, the cost can be as much as four times that of a single-level microlaminectomy. We have found that with the exception of cases involving fractures, tumors or spinal cord compressions, just about all of the cases treated with the fusion technique can be treated with a microlaminectomy technique. Endoscopic techniques for treating cervical disc disease posteriorly are being developed but the incisions employed are not much smaller than our incisions and the fact that all of our patients are dismissed home within six hours postoperative, attests to the lack of significant postoperative discomfort. The endoscopic technique markedly increases the cost of treatment.
Warren D. Parker, M.D., F.A.C.S.
You are fortunate to be living in a period of time when the concepts of traditional spine surgery are dramatically changing. Improvements in anesthesia and technological advancements in surgical techniques and equipment continue to reveal efficient new ways to perform spine surgery safely.
Minimally invasive spine procedures (e.g. microdiscectomy) are making it possible for patients to go home the day of or the day after surgery. These specialized procedures use tiny surgical instruments and small incisions, which affords patients speedier recoveries, fewer complications and less scarring.
The purpose of this article is to introduce you to the study results from an outpatient surgical procedure used to treat Cervical Radiculopathy. However, before proceeding, you need to know what cervical radiculopathy means.
What is Cervical Radiculopathy?
Cervical radiculopathy means a spinal nerve root in the neck is irritated and/or compressed. The spinal nerve roots are located in the spinal canal and the neuroforamen. The neuroforamen are small holes through which the spinal nerves exit the spinal column. Outside the spine these nerves branch off into other parts of the body forming the peripheral (outer) nervous system.
Nerve irritation may result from disc herniation, spinal stenosis, osteophyte formation or other degenerative disorders. Nerve irritation may cause sensory and/or motor abnormalities called neurologic deficit. Pain, tingling and numbness are examples of a sensory abnormality. Weakness and reflex loss are examples of a motor abnormality. Cervical radiculopathy may cause symptoms to appear in the neck, shoulders, arms, hands and fingers.
Diagnosis and Non-Surgical Treatment
An MRI or myelography and CT Scan may follow a physical examination and neurological evaluation. These tests help the spine specialist determine where the radiculopathy is located and if the patient’s symptoms correlate to the image studies.
Depending on the cause of the cervical radiculopathy, the spine specialist may first recommend non-surgical treatment. This treatment may include medication and physical therapy. Of course, not all patients are alike and some patients may require surgery.
Outpatient Surgery Study
The study involved 502 patients with cervical radiculopathy. Two hundred of these patients opted for outpatient spine surgery. The ‘outpatient’ operations were performed using general anesthesia, a posterior approach, limited tissue dissection and laminoforaminotomy at each affected level of the spine. A laminoforaminotomy is a procedure where the lamina (bony area covering posterior access to the neuroforamen) is removed, which gives the surgeon access to the affected nerve roots. During this procedure, the nerve roots are decompressed (freed from impingement).
Following surgery, each patient was observed for several hours and discharged when able to meet physical criteria such as walking without assistance. No patient required hospital admission in the post-operative period. Out of the 200 patients, 183 patients followed-up for an average of 19 months.
The outcome of each patient was determined by reviewing complications, functional outcome, recurrence of radiculopathy (symptoms) and time between surgery and return to work.
The functional outcome of each patient in this study was evaluated using the following criteria1:
|Excellent||Normal working capability in previous or comparable activity; no, or only occasional, mild residual pain|
|Good||Normal (full) working capability in previous or comparable activity; mild residual pain|
|Satisfactory||Reduced working capability; but ability to work in less heavy activity; radicular pain improved|
|Moderate||Incapable of work; radicular pain improved|
|Poor||Incapable of work; pain unchanged or worse|
The following patient outcome results include Worker’s Compensation (WC) claims involved and those not involved.
|Outcome||% Of Patients||WC Case Claims|
|Excellent/Good||92.8%||WC not involved|
Comparing the outcome between outpatient surgical treatment of cervical radiculopathy and inpatient surgical care (hospitalization), the outcomes are similar. The study shows outpatient surgical treatment is safe in selected patients. In fact, there were no infections or significant complications after outpatient surgery.
Although all patients with cervical radiculopathy are not candidates for outpatient surgery, the study results are very encouraging. The absence of post-operative infection and complications combined with successful long-term outcomes shed a bright light on the future of these procedures.
1. Tomaras CR, Blacklock JB, Parker WD, Harper RL: Outpatient surgical treatment of cervical radiculopathy. J Neurosurgery 87:41-43, 1997