Abstract
Background: To assess the clinical and radiological results of motion-segment sparing anterior cervical partial discectomy and foraminotomy surgery in patients with at least 1 year of follow-up.
Methods: The study is a prospective, non-randomized, observational study. The patients all had symptoms of intrusive nerve root irritation with or without motor symptoms, refractory to conservative management for greater than 6 weeks duration. Patients were asked to complete questionnaires capturing) VAS (visual analogue) pain scores, NDI (neck disability index) and European myelopathy scores, patient satisfaction, and return to work details. Radiographic assessments were collected preoperatively, at 4 weeks, 3 months, 6 months, 1 and 2 years postoperatively.
Results: 58 patients have been assessed with at least 1year follow-up. The mean duration of symptoms prior to surgery was 24 weeks (6–20 weeks). 55 patients had single level surgeries (C5/C6-15, C6/C7-38, C7-T1-2), 3 patients had two level surgeries (C4/C5& C5/C6-1, C5/C6& C6/C7-2). In 34 patients sugery was for soft disc prolapse, in 12 patients surgery was for hard osteophytes and in 12 patients both pathologies contributed equally. Operation time ranged from 50–85 minutes. Average in patient stay was 2.6 days. There were no complications apart from 1 patient who had to return early to theatre for evacuation of haematoma and then made a full recovery. All patients reported pain intensity reductions. Pain decreased from 6.7 to 1.4 for arm pain on a 10-point scale. NDI scores improved from a preop mean of 42 to 16 on a 100 point score at 6 months post-surgery. All patients returned to their usual occupations with the exception of 2 patients who are involved in litigation against an employer or third party. No patient required repeat surgeries. Radiographic analysis at 1 year shows preservation of segmental motion in 75% patients, preservation of interbody height in 60% patients, spontaneous fusion in 12% patients.
Conclusion: A clinical success rate of 90% was achieved (clinical success being defined as a patient rating of very satisfied or satisfied on a 5-point patient self-scoring outcome scale). 56 out of 58 patients would undergo the same procedure again and recommend it to friend.
The abstracts were prepared by Mr Colin E. Bruce. Correspondence should be addressed to Colin E. Bruce, Consultant Orthopaedic Surgeon, Alder Hey Children’s Hospital, Eaton Road, Liverpool, L12 2AP.
