1 Posterior foraminotomy for cervical radiculopathy; A comparison among direct (naked eye), microscopic and endoscopic visualization Akiyoshi Yamazaki, Keiichi Katsumi, Masayuki Ohashi, Hirokazu Shoji, Yasuaki Suhara Spine Center, Dept. of Orthop. Surg., Niigata Central Hospital, Niigata, Japan EuroSpine 2011, Oct , Milan, Italy

Cervical posterior foraminotomy is one of the standard methods that can be performed under direct (naked eye), microscopic, or endoscopic visualization.Cervical posterior foraminotomy is one of the standard methods that can be performed under direct (naked eye), microscopic, or endoscopic visualization. The purpose of this study is to compare the usefulness of posterior foraminotomy performed under these 3 ways.The purpose of this study is to compare the usefulness of posterior foraminotomy performed under these 3 ways. 2 Purpose

3 patients Osteophytes anterior to the nerve root were not removed.Osteophytes anterior to the nerve root were not removed. Disc hernia was removed as much as possible.Disc hernia was removed as much as possible. 1 level: levels: 27 3 levels: 1 4 levels: 2 Bilat. (1 level): 3 Levels Materials and Methods

4 NakedMicro Endo (METRx) difference Time Sept. ’00 – Nov. ’02 Nov. ’02 - Dec. ’05 - Patients / Discs 19 / 21 (1- 2) 104 / 133 (1- 4) 30 / 37 (1- 2) Skin incision 5 cm / level 2 cm Stenosis ： Hernia 1: 0.8 1: 0.7 1: 0.3 N.S. Age （ y ） N.S. BL （ cm ） N.S. BW （ kg ） N.S. Postop. FU （ m ） N.S.

* * p<0.05 (ANOVA) min * Results Op. time (/ level) 5

* * p<0.05 (ANOVA) cc * * Blood loss (/level) 6

7 NakedMicroEndo Motor weakness (transient) 2 (C5, 7) 1 (C7) Dural tear (pin hole) 141 Complications Not significantly different among 3 groups Neurological recovery SensorySensory MotorMotor % of facet joint preservation Ave.70% ( )

* * p<0.05 (Kruskal-Wallis) mg/dl * * CRP (P.O. 1w) 8

* * p<0.05 (ANOVA) times * * Time of analgesic usage (within P.O.1w) 9

*** * p<0.01, ** p<0.05 (ANOVA) days ** * * Hospital stay after surgery 10

11 Discussion NakedMicroEndo AdvantageEasyMicroscopicMicroscopic Small incision Less invasive DisadvantageMacroscopic More bleeding 2-D image Small working space Long op. time

Neurological recovery and % of facet joint preservation were not significantly different among 3 groups.Neurological recovery and % of facet joint preservation were not significantly different among 3 groups. With naked eyes, blood loss was significantly more due to macroscopic visualization.With naked eyes, blood loss was significantly more due to macroscopic visualization. Postoperative CRP, time of analgesic usage and hospital stay were significantly less with endoscope.Postoperative CRP, time of analgesic usage and hospital stay were significantly less with endoscope. Therefore endoscopic foraminotomy is as safe and effective as microscopic foraminotomy and even less invasive.Therefore endoscopic foraminotomy is as safe and effective as microscopic foraminotomy and even less invasive. Endoscopic foraminotomy would be preferable alternative to microscopic foraminotomy.Endoscopic foraminotomy would be preferable alternative to microscopic foraminotomy. 12 Conclusions None of the authors has any potential conflict or interest.