scholarly journals Minimally invasive posterior cervical foraminotomy with tubes to prevent undesired fusion: a long-term follow-up study

2018 ◽  
Vol 29 (4) ◽  
pp. 358-364 ◽  
Author(s):  
Conor Dunn ◽  
Jeffrey Moore ◽  
Nikhil Sahai ◽  
Kimona Issa ◽  
Michael Faloon ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Functional Outcome ◽  
Outcome Measures ◽  
Revision Rate ◽  
Cervical Radiculopathy ◽  
Adjacent Level ◽  
Posterior Cervical Foraminotomy ◽  
Outcome Scores ◽  
Cervical Foraminotomy

OBJECTIVEThe objective of this study was to compare anterior cervical discectomy and fusion (ACDF) and minimally invasive posterior cervical foraminotomy (MI-PCF) with tubes for the treatment of cervical radiculopathy in terms of the 1) overall revision proportion, 2) index and adjacent level revision rates, and 3) functional outcome scores.METHODSThe authors retrospectively reviewed the records of consecutive patients who had undergone ACDF or MI-PCF at a single institution between 2009 and 2014. Patients treated for cervical radiculopathy without myelopathy and with a minimum 2-year follow-up were compared according to the procedure performed for their pathology. Primary outcome measures included the overall rate of revision with fusion and overall revision proportion as well as the rate of index and adjacent level revisions per year. Secondarily, self-reported outcome measures—Neck Disability Index (NDI) and visual analog scale (VAS) for arm (VASa) and neck (VASn) pain—at the preoperative and postoperative evaluations were analyzed. Standard binomial and categorical comparative analyses were performed.RESULTSForty-nine consecutive patients were treated with MI-PCF, and 210 consecutive patients were treated with ACDF. The mean follow-up for the MI-PCF cohort was 42.9 ± 6.6 months (mean ± SD) and for the ACDF cohort was 44.9 ± 10.3 months. There was no difference in the overall revision proportion between the two cohorts (4 [8.2%] of 49 MI-PCF vs. 12 [5.7%] of 210 ACDF, p = 0.5137). There was no difference in the revision rate per level per year (3.1 vs. 1.7, respectively, p = 0.464). Moreover, there was no difference in the revision rate per level per year at the index level (1.8 vs. 0.7, respectively, p = 0.4657) or at an adjacent level (1.3 vs. 1.1, p = 0.9056). Neither was there a difference between the cohorts as regards the change from preoperative to final postoperative functional outcome scores (NDI, VASa, VASn).CONCLUSIONSMinimally invasive PCF for the treatment of cervical radiculopathy demonstrates rates of revision at the index and adjacent levels similar to those following ACDF. In order to confirm the positive efficacy and cost analysis findings in this study, future studies need to extend the follow-up and show that the rate of revision with fusion does not increase substantially over time.

scholarly journals Minimally Invasive Full-Endoscopic Posterior Cervical Foraminotomy Assisted by O-Arm-Based Navigation

2018 ◽  
Vol 1 (21;1) ◽  
pp. E217-E223
Author(s):  
Yue Zhou
Keyword(s):  
Minimally Invasive ◽  
Symptom Duration ◽  
Foraminal Stenosis ◽  
Arm Pain ◽  
Sf 36 ◽  
Posterior Cervical Foraminotomy ◽  
Invasive Method ◽  
Foraminal Disc Herniation ◽  
Cervical Foraminotomy

Background: Navigated percutaneous endoscopic cervical discectomy (PECD) is a promising minimally invasive surgery for treating cervical spondylotic radiculopathy. PECD has been described as a safe, effective, and minimally invasive method for patients with radiculopathy, but it comes with a steep learning curve. Due to the limited field of vision, anatomic localization is difficult for surgeons until using the O-arm based navigation. In this study, patients with radiculopathy due to foraminal disc herniation or foraminal stenosis in the lower cervical spine underwent the single level full endoscopic posterior cervical foraminotomy procedure assisted by O-arm-based navigation. Objective: The purpose of this study was to evaluate the clinical, radiological outcome and the factors predicting an excellent outcome of patients who underwent full endoscopic posterior cervical foraminotomy procedure assisted by O-arm-based navigation. Study Design: A retrospective analysis of consecutively prospectively collected data. Setting: This study was conducted by a university-affiliated hospital in a major Chinese city. Methods: Forty-two patients who had single-level foraminal disc herniation or foraminal stenosis were retrospectively reviewed. Radicular arm pain was the most common presenting symptom in patients. All patients underwent full-endoscopic posterior cervical foraminotomy assisted by O-arm-based navigation. Clinical outcomes were assessed by the visual analog scale (VAS) for neck and radicular arm pain, neck disability index (NDI), and the short form-36 health survey questionnaire (SF-36) in the immediate preoperative period, immediately postoperative, and at the final follow-up. The clinical parameters and radiological parameters included cervical curvature (CA), segmental angle (SA), and range of motion (ROM), which were assessed preoperatively and at the last follow-up. Results: The mean follow-up for the patients was 15 months. There were no perioperative complications. The VAS score for radicular arm pain and neck pain and the NDI score improved significantly in all of the patients. The SF-36 score reflected significant improvement in all 8 domains. Excellent and good outcomes were achieved in 38 out of 42 patients. The cervical curvature range of motion (CA-ROM) statistically and significantly improved at the final follow-up period compared with the preoperative period. The SA was less kyphotic after PECD at the final follow-up. The postoperative CA and CA-ROM improved but did not significantly change. On the univariate analysis, patients with a symptom duration of less than 3 months had a better outcome than patients with a symptom duration of more than 3 months (excellent, 83.33% vs. 50.00%). Limitations: This was a retrospective study with medium follow-up outcomes (mean 15 months). Conclusions: The results of this study show that the full endoscopic posterior foraminotomy assisted by O-arm-based navigation is a safe and effective option for cervical radiculopathy, with the advantages of a minimally invasive method. Patients with symptom duration less than 3 months had a better outcome than patients with symptom duration more than 3 months. Key words: Minimally invasive, cervical foraminotomy, endoscopic, navigation, O-arm, percutaneous endoscopic cervical discectomy

scholarly journals Single-level anterior cervical discectomy and fusion versus minimally invasive posterior cervical foraminotomy for patients with cervical radiculopathy: a cost analysis

2014 ◽  
Vol 37 (5) ◽  
pp. E9 ◽  
Author(s):  
Haley E. Mansfield ◽  
W. Jeffrey Canar ◽  
Carter S. Gerard ◽  
John E. O'Toole
Keyword(s):  
Minimally Invasive ◽  
Smoking Status ◽  
Cervical Radiculopathy ◽  
Direct Costs ◽  
Total Direct Cost ◽  
Single Level ◽  
Posterior Cervical Foraminotomy ◽  
The Mean ◽  
The Cost ◽  
Cervical Foraminotomy

Object Patients suffering from cervical radiculopathy in whom a course of nonoperative treatment has failed are often candidates for a single-level anterior cervical discectomy and fusion (ACDF) or posterior cervical foraminotomy (PCF). The objective of this analysis was to identify any significant cost differences between these surgical methods by comparing direct costs to the hospital. Furthermore, patient-specific characteristics were also considered for their effect on component costs. Methods After obtaining approval from the medical center institutional review board, the authors conducted a retrospective cross-sectional comparative cohort study, with a sample of 101 patients diagnosed with cervical radiculopathy and who underwent an initial single-level ACDF or minimally invasive PCF during a 3-year period. Using these data, bivariate analyses were conducted to determine significant differences in direct total procedure and component costs between surgical techniques. Factorial ANOVAs were also conducted to determine any relationship between patient sex and smoking status to the component costs per surgery. Results The mean total direct cost for an ACDF was $8192, and the mean total direct cost for a PCF was $4320. There were significant differences in the cost components for direct costs and operating room supply costs. It was found that there was no statistically significant difference in component costs with regard to patient sex or smoking status. Conclusions In the management of single-level cervical radiculopathy, the present analysis has revealed that the average cost of an ACDF is 89% more than a PCF. This increased cost is largely due to the cost of surgical implants. These results do not appear to be dependent on patient sex or smoking status. When combined with results from previous studies highlighting the comparable patient outcomes for either procedure, the authors' findings suggest that from a health care economics standpoint, physicians should consider a minimally invasive PCF in the treatment of cervical radiculopathy.

Comparing Mid-Term Outcomes Between ACDF and Minimally Invasive Posterior Cervical Foraminotomy in the Treatment of Cervical Radiculopathy

Spine ◽  
2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Arash Emami ◽  
Daniel Coban ◽  
Stuart Changoor ◽  
Conor Dunn ◽  
Nikhil Sahai ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Cervical Radiculopathy ◽  
Posterior Cervical Foraminotomy ◽  
Cervical Foraminotomy

Ambulatory Single-level Posterior Cervical Foraminotomy for Cervical Radiculopathy

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Patawut Bovonratwet ◽  
Julia S. Retzky ◽  
Aaron Z. Chen ◽  
Nathaniel T. Ondeck ◽  
Andre M. Samuel ◽  
...  
Keyword(s):  
Cervical Radiculopathy ◽  
Single Level ◽  
Posterior Cervical Foraminotomy ◽  
Cervical Foraminotomy

scholarly journals Role of leukocyte free platelet rich plasma in planter fasciitis: a prospective study

2017 ◽  
Vol 5 (12) ◽  
pp. 5432
Author(s):  
Chandre Shekhar ◽  
Alamgir Jhan ◽  
Ganesh Singh ◽  
Pankaj Singh ◽  
Shailendre S. Bhandhari
Keyword(s):  
Placebo Group ◽  
Functional Outcome ◽  
Platelet Rich Plasma ◽  
Functional Results ◽  
Visual Analogue Scale Pain ◽  
Functional Score ◽  
Outcome Scores ◽  
The Mean ◽  
Post Graduate Institute

Background: Planter fasciitis, is by definition, inflammation of planter fascia. Most of the cases are well treated conservatively and a few responds to surgery only. Objectives of present study were evaluating the efficacy of a single injection of leukocyte free platelet rich plasma in plantar fasciitis and to derive a correlation between the clinical and radiological outcome.Methods: The present study consisted of 120 patients of bilateral (PF), (240 feet). These patients were divided into two groups PRP group of 60 patients and Placebo group of 60 patients. The study was conducted on patients attending Orthopaedics outpatient department Post Graduate Institute of Medial Education and Research (PGIMER) from July 2011 to June 2012. A primary efficacy criterion was changes from baseline in pain using (VAS). Functional results, level of satisfaction and outcome were measured by – AOFAS Foot Scale. Correlation of clinical with radiological outcome were performed.Results: There was a significant decrease in the visual analogue scale (pain score) in the PRP. Group while in placebo group it was increased significantly at the end of 6 month. Functional outcome scores were improved significantly from their baseline values in PRP group while in placebo group the mean functional score were deteriorated at 6 months follow up. There was no improvement seen in functional status with normal saline injection. In PRP group the mean heal pad thickness was reduced significantly at 6 months follow up while in placebo group was not changed significantly at 6 months follow up. Correlation between radiological parameters and VAS was found to be positive while it was found negative with other functional outcome scores like AOFAS.Conclusions: Platelet-rich plasma (PRP), which is a natural concentrate of autologous growth factors,plays a role in the regeneration process in treatment of (PF).

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