Laser-assisted posterior cervical foraminotomy and discectomy for lateral and foraminal cervical disc herniation.

OBJECTIVE: Posterior cervical foraminotomy and discectomy (PCFD) is regarded as an effective treatment option for cervical radiculopathy. However, limited exposure of the disc space is one of its major disadvantages. To address this problem, we used a CO(2) laser for sophisticated decompression. The purpose of this study was to demonstrate the clinical outcomes of laser-assisted PCFD and to discuss the benefits of laser use.

METHODS: A total of 47 consecutive patients with cervical radiculopathy were treated with PCFD. Among them, 24 patients were treated with laser-assisted PCFD, and the remaining 23 patients were treated with conventional PCFD. After standard posterior cervical microscopic foraminotomy, a microscopic CO(2) laser was used for selective discectomy in the laser PCFD group. Clinical data were compared with a minimum 2-year follow-up period. Clinical outcomes were evaluated using the visual analogue scale (VAS), Neck Disability Index (NDI), and modified MacNab criteria.

RESULTS: The clinical outcomes of the two groups were similar. The mean VAS score for radicular arm pain improved from 7.42 to 1.83 in the laser PCFD group and from 8.30 to 1.65 in the conventional PCFD group. The mean NDI improved from 47.00% to 10.46% in the laser PCFD group and from 53.86% to 10.02% in the conventional PCFD group. The rate of excellent or good outcomes was 87.5% for the laser PCFD group and 86.9% for the conventional PCFD group. A significant difference between the groups was found for intraoperative bleeding. The laser PCFD group had significantly lower estimated blood loss values than did the conventional PCFD group (p<0.05).

CONCLUSIONS: Laser-assisted PCFD is an efficacious surgical option for treating lateral cervical disc herniation. The pinpoint accuracy of the laser scalpel facilitates sophisticated decompression within a limited surgical field, and may reduce the risk of intraoperative bleeding and neural damage.