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Minimally Invasive Foraminotomy Through Tubular Retractors via a Contralateral Approach in Patients With Unilateral Radiculopathy

Alimi, Marjan MD*; Njoku, Innocent Jr BS; Cong, Guang-Ting BS; Pyo, Se Young MD, PhD*; Hofstetter, Christoph P. MD, PhD*; Grunert, Peter MD*; Härtl, Roger MD*

doi: 10.1227/NEU.0000000000000358
Technique Assessment

BACKGROUND: Radiculopathy caused by foraminal nerve root compression is a common pathology in the lumbar spine. Surgical decompression via a conventional open foraminotomy is the treatment of choice when surgery is indicated. Minimally invasive tubular foraminotomy through a contralateral approach is a potentially effective surgical alternative.

OBJECTIVE: The aim of this retrospective cohort study was to evaluate the efficacy and benefits of this approach for treatment of radiculopathy.

METHODS: Patients with unilaterally dominant lower extremity radiculopathy, who underwent minimally invasive lumbar foraminotomy through tubular retractors via a contralateral approach between 2010 and 2012, were included. Oswestry Disability Index (ODI) and the Visual Analogue Scale (VAS) for back and leg pain were evaluated preoperatively, postoperatively, and at the latest follow-up. Functional outcome was evaluated by using the MacNab criteria.

RESULTS: For the total 32 patients, postoperatively there was significant improvement in the ODI (P = .006), VAS back pain (P < .001), and VAS leg pain on the pathology and the approach side (P = .004, P = .021, respectively). At follow-up of 12.3 ± 1.7 months, there was also significant improvement in the ODI (P < .001), VAS back pain (P = .001), and VAS leg pain on the pathology and the approach side (P < .001, P = .001, respectively). The functional outcome was excellent and good in 95.2%. One patient required fusion (3.1%).

CONCLUSION: A minimally invasive, facet-sparing contralateral approach is an effective technique for treatment of radiculopathy due to foraminal compression. It also allows for decompression of lumbar spinal stenosis and bilateral lateral recess decompression without the need for fusion.

ABBREVIATIONS: MIS, minimally invasive spine

ODI, Oswestry Disability Index

VAS, Visual Analogue Scale

*Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York;

Weill Cornell Medical College, New York, New York

Correspondence: Roger Härtl, MD, Weill Cornell Brain and Spine Institute, Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital 525 East 68th St, Box 99 New York, NY 10065. E-mail: roger@hartlmd.net

Received September 11, 2013

Accepted March 04, 2014

Copyright © by the Congress of Neurological Surgeons