Posterior percutaneous endoscopic cervical foraminotomy and discectomy for degenerative cervical radiculopathy using intraoperative O-arm imaging

Introduction
Posterior percutaneous endoscopic cervical foraminotomy and discectomy (P-PECD) is a minimally invasive technique for the treatment of degenerative cervical radiculopathy. The O-arm, an intraoperative mobile computed tomography (CT) scanner, may improve spine surgery outcomes.

Aim
To evaluate clinical outcomes of O-arm assisted P-PECD in patients with degenerative cervical radiculopathy.

Material and methods
Between January 2013 and January 2018, 32 patients with degenerative cervical radiculopathy who underwent P-PECD were followed up for 12 months. Their demographic, clinical and surgical data were reviewed retrospectively. All patients received intraoperative O-arm scanning to assess working cannula placement and decompression. The visual analogue scale (VAS), the neck disability index (NDI), and Odom’s criteria were used to evaluate clinical outcomes.

Results
Compared with preoperative values, mean NDI, neck-VAS, and arm-VAS scores were dramatically improved 1 week postoperatively, and the improvement was maintained for at least a year after surgery (from 27.6 ±10.5, 5.8 ±1.7, and 7.2 ±2.3 to 1.4 ±0.8, 1.1 ±0.8 and 0.9 ±0.6, respectively). According to Odom’s criteria, 27/32 patients (84.4%) reported excellent or good results. There were no permanent complications. One patient suffered from transient thumb weakness due to a cervical nerve root injury caused by the spinal needle.

Conclusions
P-PECD aided by intraoperative O-arm imaging is a safe, effective, and minimally invasive procedure for treating degenerative cervical radiculopathy that can provide accurate cannula placement and thorough decompression.