[Spinal Fusion, Microdiscectomy & Laminectomy Procedures] Cervical Laminoforaminotomy for the Treatment of Cervical Degenerative Radiculopathy (PDF)

[Justin]

Journal of Neurosurgery: Spine 11:198–202, August 2009

Cervical Laminoforaminotomy for the Treatment of Cervical Degenerative Radiculopathy

Robert F. Heary, M.D.1, Timothy C. Ryken, M.D.2, Paul G. Matz, M.D.3, Paul A. Anderson, M.D.4, Michael W. Groff, M.D.5, Langston T. Holly, M.D.6, Michael G. Kaiser, M.D.7, Praveen V. Mummaneni, M.D.8, Tanvir F. Choudhri, M.D.9, Edward J. Vresilovic, M.D., Ph.D.10, and Daniel K. Resnick, M.D.11
1Department of Neurosurgery, University of Medicine and Dentistry of New Jersey—New Jersey Medical School, Newark, New Jersey; 2Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa; 3Division of Neurological Surgery, University of Alabama, Birmingham, Alabama; 4Departments of Orthopaedic Surgery and 11Neurological Surgery, University of Wisconsin, Madison, Wisconsin; 5Department of Neurosurgery, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts; 6Division of Neurosurgery, David Geffen School of Medicine, University of California at Los Angeles, California; 7Department of Neurological Surgery, Neurological Institute, Columbia University, New York, New York; 8Department of Neurosurgery, University of California at San Francisco, California; 9Department of Neurosurgery, Mount Sinai School of Medicine, New York, New York; and 10Department of Orthopaedic Surgery, Milton S. Hershey Medical Center, Pennsylvania State College of Medicine, Hershey, Pennsylvania
Address correspondence to: Paul G. Matz, M.D., Neurosurgery and Neurology, LLC, 232 South Woods Mill Road, Chesterfield, Missouri 63017. email: matzpg at yahoo.com.

Object
The objective of this systematic review was to use evidence-based medicine to examine the efficacy of posterior laminoforaminotomy in the treatment of cervical radiculopathy.

Methods
The National Library of Medicine and Cochrane Database were queried using MeSH headings and key words relevant to posterior laminoforaminotomy and cervical radiculopathy. Abstracts were reviewed, and studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations which contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons.

Results
Posterior laminoforaminotomy improves clinical outcome in the treatment of cervical radiculopathy resulting from soft lateral cervical disc displacement or cervical spondylosis with resulting narrowing of the lateral recess. All studies were Class III. The most frequent design flaw involved the lack of utilization of validated outcomes measures. In addition, few historical studies included a detailed preoperative analysis of the patients. As such, the vast majority of studies that included both pre- and postoperative assessments with legitimate outcomes measures have been performed since 1990.

Conclusions
Posterior laminoforaminotomy is an effective treatment for cervical radiculopathy.

KEYWORDS: cervical spine; cervical spondylosis; laminotomy; practice guidelines; radiculopathy; treatment outcome.

©1944-2009 by the American Association of Neurosurgeons