Complications of Full-Endoscopic Versus Microendoscopic Foraminotomy for Cervical Radiculopathy: A Systematic Review and Meta-Analysis. 2018

Peng-Fei Wu, and Bo-Hao Liu, and Bing Wang, and Ya-Wei Li, and Yu-Liang Dai, and Ya-Long Qing, and Guo-Hua Lv
Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.

BACKGROUND Minimally invasive surgery of posterior cervical foraminotomy (PCF) for symptomatic radiculopathy has gained popularity in the last decade. It remains to be determined whether the 2 dominant operation techniques, full-endoscopic (FE) or microendoscopic (MI), are associated with fewer complications. METHODS An electronic retrieval from PubMed, Embase, and Web of Science was performed to identify comparative or single-arm studies concerning FE-PCF and MI-PCF. The pooled incidence of complications was calculated. RESULTS A total of 26 studies with 2028 patients (FE, 402; MI, 1626) were identified. The overall complication rate was 5.8% for FE-PCF and 3.5% for MI-PCF, with no significant difference (P = 0.115). The pooled complication rate for single-level radiculopathy showed no statistical difference (FE, 4.5%; MI, 3.5%; P = 0.471), either. However, constituent of complications showed apparent disparity, with transient root palsy in FE-PCF (15/19, 78.9%) and dural tear (20/47, 42.6%) in MI-PCF being the most commonly reported. As for the subgroup analysis, both incidence of dural tear (FE, 1.5%; MI, 1.8%; P = 0.672) and superficial wound infection (FE, 2.2%; MI, 1.0%; P = 0.109) showed no statistical difference. Nevertheless, transient root palsy occurred at a higher incidence in the FE group than in the MI group (FE, 4.5%; MI, 1.5%; P = 0.002). CONCLUSIONS Both FE-PCF and MI-PCF can offer relatively safe treatment for cervical radiculopathy. There is no significant difference in overall complication rate between the 2 techniques. Dural tear is the most commonly reported complication of MI-PCF, whereas transient root palsy deserves to be noticed for surgeons performing FE-PCF.

UI MeSH Term Description Entries
D008866 Microsurgery The performance of surgical procedures with the aid of a microscope.
D011183 Postoperative Complications Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. Complication, Postoperative,Complications, Postoperative,Postoperative Complication
D011843 Radiculopathy Disease involving a spinal nerve root (see SPINAL NERVE ROOTS) which may result from compression related to INTERVERTEBRAL DISK DISPLACEMENT; SPINAL CORD INJURIES; SPINAL DISEASES; and other conditions. Clinical manifestations include radicular pain, weakness, and sensory loss referable to structures innervated by the involved nerve root. Nerve Root Avulsion,Nerve Root Compression,Nerve Root Disorder,Radiculitis,Nerve Root Inflammation,Radiculopathy, Cervical,Avulsion, Nerve Root,Avulsions, Nerve Root,Cervical Radiculopathies,Cervical Radiculopathy,Compression, Nerve Root,Compressions, Nerve Root,Inflammation, Nerve Root,Nerve Root Avulsions,Nerve Root Compressions,Nerve Root Disorders,Nerve Root Inflammations,Radiculitides,Radiculopathies,Radiculopathies, Cervical
D002574 Cervical Vertebrae The first seven VERTEBRAE of the SPINAL COLUMN, which correspond to the VERTEBRAE of the NECK. Cervical Spine,Cervical Spines,Spine, Cervical,Vertebrae, Cervical
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D016032 Randomized Controlled Trials as Topic Works about clinical trials that involve at least one test treatment and one control treatment, concurrent enrollment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process, such as the use of a random-numbers table. Clinical Trials, Randomized,Controlled Clinical Trials, Randomized,Trials, Randomized Clinical
D044583 Neuroendoscopy PROCEDURES that use NEUROENDOSCOPES for disease diagnosis and treatment. Neuroendoscopy, generally an integration of the neuroendoscope with a computer-assisted NEURONAVIGATION system, provides guidance in NEUROSURGICAL PROCEDURES. Neuroendoscopies
D059526 Foraminotomy Surgical enlargement of the intervertebral foramina to relieve NERVE ROOT COMPRESSION. Foraminotomies
D019060 Minimally Invasive Surgical Procedures Procedures that avoid use of open, invasive surgery in favor of closed or local surgery. These generally involve use of laparoscopic devices and remote-controlled manipulation of instruments with indirect observation of the surgical field through an endoscope or similar device. Minimal Access Surgical Procedures,Minimal Surgical Procedures,Minimally Invasive Surgical Procedure,Surgical Procedures, Minimally Invasive,Minimal Surgical Procedure,Minimally Invasive Surgery,Procedure, Minimal Surgical,Procedures, Minimal Access Surgical,Procedures, Minimal Surgical,Procedures, Minimally Invasive Surgical,Surgical Procedure, Minimal,Surgical Procedures, Minimal,Surgical Procedures, Minimal Access,Minimally Invasive Surgeries,Surgeries, Minimally Invasive,Surgery, Minimally Invasive

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