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Minimally invasive cervical laminoforaminotomy - Technique and outcomes.

ABSTRACT:

Background

Cervical radiculopathy is a common pathological entity encountered by spine surgeons. Many surgical options have been described including anterior cervical discectomy with or without fusion to arthroplasty and posterior cervical laminoforaminotomy. Being a motion-preserving procedure, posterior cervical laminoforaminotomy is an excellent treatment for patients with unilateral radiculopathy secondary to a laterally located herniated disc or foraminal stenosis. With the advent of minimally invasive techniques, this procedure has regained popularity.

Objectives

Although there is enough evidence in the literature highlighting the benefits, safety, and efficacy of minimally invasive versus conventional techniques, a detailed technical report along with long-term surgical outcomes is lacking.

Methods

The authors present their experience in minimally invasive cervical laminoforaminotomy (MIS-CLF) over a 7-year period (2013-2020) along with a technical note. Clinical evaluation was performed both before and after surgery, using the Visual Analog Scale (VAS) pain scores. Patient functional outcome was measured using the modified Odom's criteria.

Results

There were no major perioperative complications. No patient required surgery for the same level during the follow-up period which ranged from 1 to 3 years. Statistically significant results were obtained in all cases, reflected by an improvement in VAS for neck/arm pain.

Conclusion

MIS-CLF is an effective technique for treatment of radiculopathy due to cervical disc herniation in a carefully selected subgroup of patients with good medium- to long-term outcomes. A larger study would possibly highlight the effectiveness of this procedure.

SUBMITTER: Srikantha U

PROVIDER: S-EPMC8740814 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BACKGROUND:Minimally invasive surgery was adopted as an alternative to laparotomy (open surgery) for radical hysterectomy in patients with early-stage cervical cancer before high-quality evidence regarding its effect on survival was available. We sought to determine the effect of minimally invasive surgery on all-cause mortality among women undergoing radical hysterectomy for cervical cancer. METHODS:We performed a cohort study involving women who underwent radical hysterectomy for stage IA2 or IB1 cervical cancer during the 2010-2013 period at Commission on Cancer-accredited hospitals in the United States. The study used inverse probability of treatment propensity-score weighting. We also conducted an interrupted time-series analysis involving women who underwent radical hysterectomy for cervical cancer during the 2000-2010 period, using the Surveillance, Epidemiology, and End Results program database. RESULTS:In the primary analysis, 1225 of 2461 women (49.8%) underwent minimally invasive surgery. Women treated with minimally invasive surgery were more often white, privately insured, and from ZIP Codes with higher socioeconomic status, had smaller, lower-grade tumors, and were more likely to have received a diagnosis later in the study period than women who underwent open surgery. Over a median follow-up of 45 months, the 4-year mortality was 9.1% among women who underwent minimally invasive surgery and 5.3% among those who underwent open surgery (hazard ratio, 1.65; 95% confidence interval [CI], 1.22 to 2.22; P=0.002 by the log-rank test). Before the adoption of minimally invasive radical hysterectomy (i.e., in the 2000-2006 period), the 4-year relative survival rate among women who underwent radical hysterectomy for cervical cancer remained stable (annual percentage change, 0.3%; 95% CI, -0.1 to 0.6). The adoption of minimally invasive surgery coincided with a decline in the 4-year relative survival rate of 0.8% (95% CI, 0.3 to 1.4) per year after 2006 (P=0.01 for change of trend). CONCLUSIONS:In an epidemiologic study, minimally invasive radical hysterectomy was associated with shorter overall survival than open surgery among women with stage IA2 or IB1 cervical carcinoma. (Funded by the National Cancer Institute and others.).