Acta Neurochir (2017) 159:2369–2377
Single-level unilateral posterior cervical foraminotomy is regarded as a safe method. However, the outcomes of posterior cervical foraminotomy performed on two or three levels are uncertain and debated. We aimed to analyze the long-term clinical and radiological outcomes of posterior cervical foraminotomy at two or three levels.
Methods From September 2008 to December 2011, a total of 42 patients who underwent a posterior cervical foraminotomy at two or three levels and were followed for at least 3 years were analyzed with retrospective cohort study. Clinical assessments were performed using the visual analog scale (VAS), neck disability index (NDI) and modified MacNab criteria. Radiological evaluation included the assessment of static and dynamic lateral radiographs to identify instability, postlaminectomy kyphotic deformity, adjacent segmental degeneration (ASD), and focal degeneration.
Results The mean VAS improved from preoperative score 8.5 ± 0.3 to postoperative score 1.8 ± 0.5 significantly. The mean presenting NDI score was 32.9 ± 2.0 and the mean postoperative NDI score was 14.2 ± 1.3. Improvement of radiculopathy was displayed in 39 patients (92.9%). During radiological evaluation, no significant change in disc height related to ASD and focal degeneration was noted. However, we confirmed one patient with radiological instability and one patient with radiological postlaminectomy kyphotic deformity.
Conclusions Posterior cervical foraminotomy at two or three levels is fairly effective for treating patients with cervical radiculopathy, and results in long-lasting pain relief and improved quality of life in nearly all patients. However, further studies of three levels that include more patients are needed.