Navigated posterior cervical microforamitomy (PCM) is a promising minimally invasive technique for treating radiculopathy caused by lateral disc herniations and foraminal stenosis. The aim of this paper is to describe the surgical technique and clinical results of minimally invasive posterior cervical microforaminotomy (PCM) assisted by an O-arm-based navigation system for the treatment of unilateral radiculopathy in the lower cervical and C-T junction.
Methods: Fourteen patients who have unilateral foraminal disc herniations or foraminal stenosis at C6-7 or C7-T1 level underwent PCM assisted by O-arm navigation using the METRx tubular retractor between December 2009 and October 2010. Main symptoms were radicular arm pain with no significant neck pain.
Results: Successful relief of radicular pain was achieved in all fourteen patients. Follow-up loss was observed in 2 patients. Three of them had to have further decompression due to remained foraminal stenosis after checking intraoperative O-arm images. There were no cases of instability or recurrence. The only complication observed was a dural tear in one patient, which was adequately treated with fibrin glue and bed rest. The duration of the symptoms was 4.5 months on average. The operation time was 136 minutes on average. Additional time for the image guidance surgery based on O-arm based navigation was about 28 minutes on average. There were no other complications during the surgical procedure or the immediate post-operative time.
Conclusions: Posterior cervical microforaminotomy assisted by O-arm-based navigation is a safe, efficient and minimally invasive procedure in the treatment of lateral disc herniations and foraminal stenosis of the lower cervical spine and C-T junction, and offers the advantages of an accurate decompression associated with a reduced risk of segmental instability.