Transtubular microsurgical approach to treat lateral cervical disc herniation

OBJECTIVE: The cervical spine offers different surgical options to treat radicular pain syndromes. Employing the posterior approach for foraminotomy and sequestrectomy (Frykholm) fusion can be avoided, but neck pain affects the postoperative course. This retrospective study compares the classical Frykholm approach and the transtubular microsurgical approach for foraminotomy.

METHODS: From 2004 to 2012, 40 patients fulfilled the inclusion criteria and were enrolled into this retrospective study. The classical Frykholm approach was performed on 25 affected levels. The transtubular microsurgical approach was used on 19 affected levels. Endpoints were neck pain, radicular pain, surgery time, hospital stay and long-term outcomes.

RESULTS: For the transtubular microsurgical approach and the classical Frykholm approach, the mean surgery time was 77.65 ± 23 min and 104 ± 27.59 min (p=0.003), respectively. Radicular pain improved in all patients regardless to the technical approach. Significant differences were observed in neck pain on the first postoperative day (p=0.003) and at discharge (p=0.006), resulting in a shorter hospital stay of 4.82 days ± 2.1 for the transtubular microsurgical approach in comparison to 7.43 days ± 3.2 for the Frykholm approach (p=0.005). According to Odom's criteria, the rate of an excellent or good outcome was 97.5% (67.5% excellent and 30% good), without any differences between the compared approaches.

CONCLUSION: The transtubular microsurgical approach shows advantages regarding postoperative neck pain, surgery time and hospital stay with a trend towards an earlier return to work.