• Peng-Fei Wu, Ya-Wei Li, Bing Wang, Bin Jiang, Zhi-Ming Tu, and Guo-Hua Lv.
• Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; School of Life Sciences, Center for Medical Genetics , Central South University, Changsha, Hunan, China.
• Pain Physician. 2019 Jan 1; 22 (1): 41-52.

BackgroundRecently posterior cervical foraminotomy (PCF) performed using a minimally-invasive surgery (MIS) approach for cervical radiculopathy due to lateral disc herniation or osseous foraminal stenosis has gained popularity. As 2 dominating MIS techniques, whether FE-PCF or MI-PCF provides superior clinical outcomes remains controversial.ObjectivesTo compare clinical success rate, overall incidence of complications and reoperation rate between full-endoscopic posterior cervical foraminotomy (FE-PCF) and microendoscopic posterior cervical foraminotomy (MI-PCF) for cervical radiculopathy.Study DesignA systematic review and meta-analysis.MethodsA literature search of Pubmed, Embase and Web of Science was conducted to identify comparative or single-arm studies concerning FE-PCF or MI-PCF. The pooled results were performed by calculating the effect size based on the logit event rate and reported with 95% confidence intervals (CI).ResultsA total of 26 articles with 2003 patients (FE-PCF, 377; MI-PCF, 1626) were included. The pooled clinical success rate was 93.6% (CI: 90.0%-95.9%) for the FE group and 89.9% (CI: 86.6%-92.5%) for the MI group, which was not statistically significant (P = 0.908). Overall complication rates were 6.1% (CI: 3.2%-11.3%) and 3.5% (CI: 2.7%-4.6%) for the FE group and the MI group, respectively, with no significant difference (P = 0.128). Nevertheless, the specific constituents showed apparent disparity, with transient nerve root palsy in the FE group (12/16, 75.0%) and dural tear in the MI group (20/47, 42.6%) being the most commonly reported. the pooled reoperation rate, the FE group (4.8%, CI: 2.9%-7.8%) and the MI group (5.3%, CI: 3.4%-8.2%), also demonstrated no statistical difference (P = 0.741).LimitationsThe indirect comparison eroded the reliability of results inevitably due to the paucity of randomized clinical trials or high quality prospective cohort studies.ConclusionsBoth FE-PCF and MI-PCF can offer an effective and relatively secure treatment for cervical radiculopathy. There was no significant difference in the pooled outcomes of clinical success rate, complication rate and reoperation rate between the 2 approaches.Key WordsCervical radiculopathy, full-endoscopic, microendoscopic, posterior cervical foraminotomy, clinical outcome, complication, reoperation, meta-analysis.

13 keywords...

hide…