Location

Philadelphia Campus

Start Date

7-5-2014 1:00 PM

Description

Intro: Anterior cervical foraminotomy (ACF) is a novel approach involving direct decompression of nerve from an offending agent without fusion. Historically, several anterior and posterior approaches were utilized to treat cervical radiculopathy. Anterior cervical discectomy necessitates fusion and is subject to adjacent segment disease as well as loss of ROM. Posterior laminoforaminotomy seldom allows for removal of disc fragment and is associated with higher postoperative pain.

Methods: Between May 2010 and March 2013, 16 patients with one or two level cervical spondylosis with radiculopathy without myelopathy who failed conservative therapies such as anti-inflammatory medications, physical therapy or injections underwent anterior foramintomy. All patients underwent pre-operative MRI that confirmed either a “soft” disc, spondylytic spur or a combination of the two. 15 of the 16 patients had no prior surgery. One had a prior ACDF at an adjacent level. All patients were assessed at two weeks for a wound check and again at two months. The visual analog score was used to assess their pre-operative and post-operative pain symptoms. A paired t test was used to compare pre- and post-operative VAS. Significance was accepted at a value of p < 0.05.

Results: The average VAS pre-operatively was 7.75 and the average VAS score post-operatively was 1.1 (p value 0.02). All but two patients with weakness returned to normal strength. Of the 13 patients that had pre-operative parasthesias only five had residual symptoms, all of which they described as improved compared to their pre-operative symptoms. OR times ranged from 97-174 minutes with a mean of 124.6 minutes.

Conclusion: ACF is an alternative to standard posterior and anterior cervical operations for the treatment of cervical radiculopathy. In our study patients had good short term outcomes, however long term data needs to be obtained. ACF is a motion preserving operation and comparative data should be obtained between cervical disc arthroplasty and ACF.

COinS
 
May 7th, 1:00 PM

Anterior Cervical Foraminotomy: Short Term Outcomes In Patients With Isolated Cervical Radiculopathy

Philadelphia Campus

Intro: Anterior cervical foraminotomy (ACF) is a novel approach involving direct decompression of nerve from an offending agent without fusion. Historically, several anterior and posterior approaches were utilized to treat cervical radiculopathy. Anterior cervical discectomy necessitates fusion and is subject to adjacent segment disease as well as loss of ROM. Posterior laminoforaminotomy seldom allows for removal of disc fragment and is associated with higher postoperative pain.

Methods: Between May 2010 and March 2013, 16 patients with one or two level cervical spondylosis with radiculopathy without myelopathy who failed conservative therapies such as anti-inflammatory medications, physical therapy or injections underwent anterior foramintomy. All patients underwent pre-operative MRI that confirmed either a “soft” disc, spondylytic spur or a combination of the two. 15 of the 16 patients had no prior surgery. One had a prior ACDF at an adjacent level. All patients were assessed at two weeks for a wound check and again at two months. The visual analog score was used to assess their pre-operative and post-operative pain symptoms. A paired t test was used to compare pre- and post-operative VAS. Significance was accepted at a value of p < 0.05.

Results: The average VAS pre-operatively was 7.75 and the average VAS score post-operatively was 1.1 (p value 0.02). All but two patients with weakness returned to normal strength. Of the 13 patients that had pre-operative parasthesias only five had residual symptoms, all of which they described as improved compared to their pre-operative symptoms. OR times ranged from 97-174 minutes with a mean of 124.6 minutes.

Conclusion: ACF is an alternative to standard posterior and anterior cervical operations for the treatment of cervical radiculopathy. In our study patients had good short term outcomes, however long term data needs to be obtained. ACF is a motion preserving operation and comparative data should be obtained between cervical disc arthroplasty and ACF.