Posterior microlaminoforaminotomy for cervical disc herniation

Background and purpose: Posterior microlaminoforaminotomy is a surgical treatment option for lateral cervical disc herniation. This approach avoids injury of vital structures lying in front of the cervical spine and preserves mobility of the treated spinal segment. The authors present the outcome of 20 patients operated on using this method. Material and methods: Retrospective analysis was performed on 20 consecutive patients operated on in the years 2005-2009. Posterior microlaminoforaminotomy was used in patients with unilateral cervical radiculopathy resulting from lateral disc herniation. Osteophytes coexisted in 12 cases. The presenting symptoms were: radicular pain (20 patients), paraesthesias (19), neck pain (17), dermatomal sensory loss (11) and motor deficit (9 patients). All operations were performed at a single level (C5/C6 in 8 cases, C6/C7 in 10 cases, C7/Th1 in 2 cases). Results: The herniated disc was removed in 19 cases; nerve root decompression was performed in 1 patient. Osteophytes were additionally excised in 4 cases. Significant relief of radicular pain was achieved in all cases early after surgery. Transient improvement with unsatisfactory late outcome was observed in 1 patient. Satisfactory late outcome (according to Odom's criteria) was obtained in 95% (18/19) of patients. Complete or marked improvement of radicular pain was observed in 95% (18/19), neck pain in 94% (16/17), sensory loss in 82% (9/11) and motor deficit in 78% (7/9). There was no case of spinal instability or secondary operation due to recurrence with a mean follow-up period of 22 months. Conclusions: Posterior microlaminoforaminotomy is safe and effective. Coexistence of osteophytes does not limit use of this technique. The risk of herniation recurrence and spinal instability is very low. The minimal invasiveness of this method allows faster return to normal life activities.