Evaluating Three-Dimensional Navigation versus Conventional Fluoroscopy for Posterior Cervical Foraminotomy: An Exploratory Cohort Comparison

Journal of Neurological Surgery Part A Central European Neurosurgery, vol. 87, pp. 346–352

Abstract

Background: Unilateral monosegmental radiculopathy, caused by foraminal soft disc nerve root compression, can be treated with posterior cervical foraminotomy (PCF). Conventional fluoroscopy is widely used for level localization and verifying decompression extent intraoperatively. However, the failure rate increases, especially in obese patients and the lower cervical spine. Can intraoperative three-dimensional (3D) navigation improve outcomes in PCF compared with conventional fluoroscopy? Materials and Methods: In this retrospective study, we analyzed two groups: 42 patients (mean age: 54 ± 10 years) who underwent PCF using intraoperative 3D navigation (study group) and 63 patients (mean age: 51 ± 11 years) who underwent PCF with conventional fluoroscopy (control group). Each cohort was divided into upper (C3-C6) and lower cervical spine (C6-T1) subgroups. Differences were explored by Mann-Whitney U and Friedman tests. Results: Both groups experienced significant postoperative symptom improvement, with no significant neurological differences. Subgroup analyses revealed no significant differences between surgeries in the upper (C3-C6) and lower (C6-T1) cervical spine. Only blood loss in the C3-C6 group differed significantly between control and study groups. Conclusion: Intraoperative 3D navigation was successfully used for PCF, resulting in significant symptom relief. Outcomes after PCF with 3D navigation appeared comparable to those achieved with conventional fluoroscopy, without statistical evidence of a clear advantage. Thus, technical complexity should be considered when selecting the surgical method.

Authors 10

1. Christian Blume Aachen Department of Neurosurgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Neurosurgery, University Hospital RWTH Aachen, Aachen, North Rhine-Westphalia, Germany

2. Andrej Bitter Aachen Department of Neurosurgery

   Universitätsklinikum Aachen · Krankenhaus Neuwerk "Maria von den Aposteln" · RWTH Aachen University

   Affiliation as printed

   Department of Neurosurgery, University Hospital RWTH Aachen, Aachen, North Rhine-Westphalia, Germany

   Department of Orthopedics and Trauma Surgery, Neuwerk Hospital Mönchengladbach, Mönchengladbach, North Rhine-Westphalia, Germany

3. Guido Wapenhans

   Krankenhaus Neuwerk "Maria von den Aposteln"

   Affiliation as printed

   Department of Orthopedics and Trauma Surgery, Neuwerk Hospital Mönchengladbach, Mönchengladbach, North Rhine-Westphalia, Germany

4. Patrick Weidle

   Krankenhaus Neuwerk "Maria von den Aposteln"

   Affiliation as printed

   Department of Orthopedics and Trauma Surgery, Neuwerk Hospital Mönchengladbach, Mönchengladbach, North Rhine-Westphalia, Germany

5. Kerstin Jütten Aachen Department of Neurosurgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Neurosurgery, University Hospital RWTH Aachen, Aachen, North Rhine-Westphalia, Germany

6. Miguel Pishnamaz Aachen Department of Orthopaedics, Trauma and Reconstructive Surgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, North Rhine-Westphalia, Germany

7. Alexander Romagna

   München Klinik Bogenhausen

   Affiliation as printed

   Department of Neurosurgery, München Klinik Bogenhausen, Munich, Bayern, Germany

8. Ulf Bertram Aachen Department of Neurosurgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Neurosurgery, University Hospital RWTH Aachen, Aachen, North Rhine-Westphalia, Germany

9. Hans Clusmann Aachen Department of Neurosurgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Neurosurgery, University Hospital RWTH Aachen, Aachen, North Rhine-Westphalia, Germany

10. Tobias Philip Schmidt corresponding Aachen Department of Neurosurgery

    Universitätsklinikum Aachen · RWTH Aachen University

    Affiliation as printed

    Department of Neurosurgery, University Hospital RWTH Aachen, Aachen, North Rhine-Westphalia, Germany