Objective To evaluate the cl inical results of posterior microendoscopic foraminotomy in the treament of cervical radiculopathy and cervical intervertebral disc protrusion. Methods From February 2004 to June 2007, 24 cases of cervical radiculopathy received posterior microendoscopic foraminotomy. There were 16 males and 8 females, aging 42-68 years (59 years on average), including 16 cases of cervical radiculopathy and 8 cases of cervical intervertebral disc protrusion.The course of disease was 6-15 months. The affected intervertebral discs were C4, 5 in 8 cases, C5, 6 in 12 cases, and C6, 7 in 4 cases. The radiological examinations showed that 8 protrusions included 6 soft tissue protusions and 2 rigid tissue protusions, and that cervical radiculopathy were caused by yellow l igament hypertrophy, Luschka’s joint hyperplasia, and abnormal position of facet joint. According to Japanese Orthopedic Association (JOA), the score before operation was (12.60 ± 1.52) points. Results The operation time was 90 to 120 minutes (100 minutes on average), the bleeding during operation was 100 to 150 mL (120 mL on average). Nerve root pain were rel ieved completely in 19 cases and were rel ieved partly in 4 cases. One case of calcified nucleus pulposus had neurological traction injury and recovered completely after 3 months. All cases were followed up 24-36 months (28 months on average). The radiological examinations after operation showed the intervertebral disc site was decompressed completely and the height of intervertebral disc and the cervical segmental al ignment were normal. At 24 months postoperatively, the JOA score was (16.10 ± 0.29) points, showing significant difference when compared with that of preoperation (P lt; 0.01). Conclusion The posterior microendoscopic foraminotomy can get to the operation site with miniincision, decrease tissue damage during operation, and avoid narrow intervertebral space, so it has satisfactory cl inical results.
Objective To make a clinical analysis on the patients with triceps paralysis caused by cervical radiculopathy.Methods From May 1998 to November 2003, 15 patients (11 males, 4 females, aged 34-76 years) with cervical radiculopathy were analyzed retrospectively, who had no symptoms of the compressed pyramidal tract of the medulla. The affection occurred at C3,4 in 1 patient, at C4,5 in 9 patients and at C5,6in 5 patients. According to the Yamazaki classification, there were 4 patients with the paramedian disc protrusion, 5 with the lateral disc protrusion，4 with the uncovertebralosteophyte, and 2 with the superior articular process hypertrophy. All the patients complained of the unilateral shoulder weakness, especially on abduction. Muscle atrophy occurred when radiculopathy was serious. There was a radicular painin the shoulder, the scapular region, and the forearm. Some of the patients haddysesthesia but with no pathological reflex, symptoms of the pyramidal tract ofthe medulla or hyperreflexia of the tendon reflex on the neurological examination. Before operation, the triceps strength was 2.40±0.51, the scale of the nerve root symptoms was 7.60±1.45, and the width of the intervertebral foramina on MRI was 2.90±0.15 mm. Of the patients, 13 had undergone the anterior cervical discectomy, the uncovertebral joint recection, and uncoforaminotomy; 2 had undergone the posterior medial facetectomy and foraminotomy to decompress the nerve root. Results According the follow-up for 16-24 months averaged 19.4 months revealed that the pain was obviously relieved, the scale of the nerve root symptoms was 3.34 ± 0.62, the triceps strength was enhanced to 4.40 ± 0.74, and the width of the intervertebral foramina was 4.07±0.16 mm. There was a significant difference postoperatively when compared with preoperatively (Plt;0.01）. Conclusion The cervical radiculopathy is usuallyaccompanied by the cervical spondylosis myelopathy. It is rarely encountered that the disease happened alone with no symptoms of the compressed pyramidal tractof the medulla. The disease is related to the foraminal disc herniation, the foraminal osteophyte formation, and the processus articularis proliferation. The treatment of choice is resection of the osteophyte or the herniated disc, and decompression of the nerve root.