35. The restoration of cervical lordosis in preoperative kyphotic spines after uniportal posterior percutaneous endoscopic cervical foraminotomy: a single center retrospective study

Abstract

BACKGROUND CONTEXT

Posterior percutaneous endoscopic cervical foraminotomy (P-PECF) offers an alternative to anterior cervical discectomy and fusion (ACDF) for patients with cervical radiculopathy, demonstrating comparable results in pain relief and functional recovery. However, the clinical and radiological outcome of P-PECF in kyphotic spine patients preoperative cervical remains uncertain.

PURPOSE

This study investigates whether patients with preoperative kyphotic spines with cervical radiculopathy are suitable candidates for P-PECF using a single incision.

STUDY DESIGN/SETTING

A retrospective study of 24 kyphotic spine patients with cervical radiculopathy receiving P-PECF at our institute from March 2019 to October 2023 was performed. All patients received P-PECF operation with the L-STEP (Lu's medial Superior articular process Total Enbloc removal and partial pediculotomy) technique to maximize the extent of foraminotomy and ensure the the cervical nerve root not repeatedly being compressed.

PATIENT SAMPLE

There were 24 patients with preoperative kyphotic spine patients in total included in our study.

OUTCOME MEASURES

Clinical outcomes were assessed using the visual analogue scale (VAS) for arm pain preoperatively and one year postoperatively. Radiological outcomes were evaluated preoperatively and one year postoperatively, including the C2-7 lordotic curve, cervical straight vertical alignment (cSVA), C7 slope, flexion range of motion (fROM) and extension range of motion (eROM).

METHODS

The data were analyzed using IBM SPSS (version 22, IBM Corporation) and GraphPad Prism (version 8.0.0). Descriptive analysis for continuous and categorical variables was provided, including mean, standard deviation, and percentage. Comparative analysis of perioperative factors and radiological factors before and after P-PECF was performed using a paired t-test for continuous variables. Chi-square tests and Fisher’s exact tests were performed for categorical variables. Statistical significance was defined as a p-value of less than 0.05.

RESULTS

Significant postoperative improvement in VAS-arm scores was noted postoperatively (p=0.00). Significant restoration of cervical lordosis, from -5.2°±3.80 preoperatively to 0.94°±7.38 postoperatively (p=0.001) was noted, while the global cervical sagittal alignment and range of motion remained unchanged.

CONCLUSIONS

This is the first study examining the clinical and radiological outcome of uniportal single-incision P-PECF in preoperative kyphotic spines.impact of preoperative cervical curvature on clinical and radiological outcomes after uniportal single-incision P-PECF. The results indicate that P-PECF, either single level or multilevel, effectively restores cervical lordosis in kyphotic spine patients.

FDA Device/Drug Status

This abstract does not discuss or include any applicable devices or drugs.