Purpose: Published series of minimally invasive cervical foraminotomy (MICF) have shown excellent short-term relief of cervical radiculopathy (85–98%) with minimal surgical morbidity. There have been no long-term clinical series documenting the stability of these results over time. This is the first long-term follow-up of MICF patients to determine the incidence of recurrent symptoms and need for additional cervical spine surgery.

Methods: We conducted a multi-center retrospective chart review of 73 patients who had MICF. Clinical outcome measures were assessed from clinic records, operative records, and telephone surveys.

Results: At 3 months, 70/73 patients (96%) reported relief of radicular pain compared to their preoperative state. By 40 months, 15 patients reported symptoms of cervical radiculopathy. 8 patients experienced recurrent symptoms, and the remaining 7 had a new radicular pattern. Of 7 patients with symptoms at new levels, 6 had pre-existing radiographic abnormality. 15 patients underwent additional cervical surgery after MICF. 3 patients underwent repeat MICF at the same level. An additional 2 patients had MICF at a different level. 7 patients had ACDF at the same level and 2 had fusion at a different level. There were no cases of frank instability or spondylolisthesis noted.

Conclusions: At 40 month follow-up, 21% or patients had radicular symptoms with 11% reporting recurrence of preoperative symptoms and 9% with radicular symptoms in a different distribution. 12% (9/73 patients) of the group required ACDF within the follow-up period. Thus, 64/73 patients were spared fusion in this series. Assuming the 2.5% per year incidence of adjacent level fusion cited in the literature, there would have been 6 cases likely to have required another fusion if all 73 patients had been treated with ACDF initially. From this perspective, MICF continues to be our procedure of choice for properly selected patients with cervical radiculopathy.