Posterior cervical foraminotomy versus anterior cervical cage with fusion

Abstract

The surgery of the cervical spine is one of the common surgeries in Neurosurgery. This is attributed to the high number of patients with complaints related to lesions in this part of the spine. Many approaches have been invented to deal with such lesions. Of the common lesions encountered in the practice of neurosurgery in relation to the cervical spine are disc prolapse, cervical canal stenosis, cervical spondylosis, fractures of the cervical spine and tumors arising either from the cord or from the bony spine. ACDF is a common and long-standing surgical intervention for symptomatic degenerative cervical spinal disease (Mohamad Bydon, 2014). ACDF is the generally preferred treatment for radiculopathy when there is a significant component of axial neck pain, when the disease is centrally located, or when there is any degree of segmental kyphosis (Albert TJ and Murrell SE, 2008). Posterior laminoforaminotomy is a well-established technique for cervical radiculopathy, first described in the mid-20th century by Spurling and Scoville, and soon after by Frykholm. However, during the past 4 decades, the anterior cervical approach with or without inter-body fusion has been widely adopted for the treatment of cervical radiculopathy. This trend toward anterior discectomy for all types of cervical discs has been observed (Jeffrey G. Clark et al, 2011). The aim of this work is to compare between cervical laminoforaminotomy ( posterior approach) and ACDF ( anterior approach) as regard indications, complications and shortterm outcome (immediate, three months and six months) of each in management of posterolateral cervical disc prolapse. Twenty patients with CDP were included in this study, they presented with different complaints, namely unilateral brachialgia (numbness and tingling), weakness, neck pain, occipital headache, focal parascapular pain, arm, forearm and hand pain. On examination, different signs were noted, motor, and sensory deficit, reflex changes in few cases. Summary 80 Different investigations were done including laboratory investigations and different imaging studies such as plain X-ray films, CT scan and MRI. Electro physiological study was done in few cases when indicated. All cases were subjected to either cervical laminoforaminotomy 50% of cases and the other 50% of cases performed ACDF. The details of these approaches were reviewed and so are the complications we faced whether intra-operatively or post-operatively for a period of six months. The most common level affected was C6-7 in group 1 (half of cases), while in group 2, C5-C6 is the most affected level which represent 40% of the study. Complications include sever neck pain and dysphagia were common in group1. patients who underwent posterior surgeries lost more blood intraoperatively than those who received ACDF, and had a shorter length of hospitalization compared with patients in the anterior surgery, however they were not significantly different between the two groups. The statistical evaluation showed a significant difference in brachialgia based on VAS between the preoperative state for both groups and the immediate post operative and follow ups at 3, 6 months. There was a highly significant improvement as regard motor weakness at 6 months follow up in comparison with the preoperative status in group 1 based on MMT, however there was no significant improvement in group 2. All patients showed total improvement of brachialgia (100% in group1 and 30% in group 2) after six months of the intervention these results are better than those obtained in treatment of weakness. In our series, there was a Statistically significant and clinically relevant post operative improvements were seen in both groups in comparison with the pre operative state, however the improvement in brachialgia together with motor deficits were better in group1 than in group 2 at 6 months follow up. Summary 81 Notably, patients receiving ACDF had significantly higher rates of clinical improvement compared with the posterior approach at the last follow-up. The outcomes in the study were gathered and compared with other studies, as regards the indications, surgical aspects, out come and the complications.