Perioperative Complications Associated With Cervical Microendoscopic Foraminotomy (CMEF) And Its Solution

Presented at SMISS Annual Forum 2014
By Yukihiro Nakagawa MD, PhD
With Munehito Yoshida MD, PhD, Hiroshi Yamada MD, PhD, Hiroshi Hashizume MD, PhD, Akihito Minamide MD, PhD, Hiroshi Iwasaki MD, PhD, Shunji Tsutsui MD, PhD, Hideto Nishi MD, PhD,

Disclosures: Yukihiro Nakagawa MD, PhD Munehito Yoshida MD, PhD , Hiroshi Yamada MD, PhD None, Hiroshi Hashizume MD, PhD None, Akihito Minamide MD, PhD , Hiroshi Iwasaki MD, PhD None, Shunji Tsutsui MD, PhD , Hideto Nishi MD, PhD ,

Introduction:
Cervical microendoscopic foraminotomy (CMEF) is one of minimally invasive procedures for cervical radiculopathy. CMEF is a useful procedure, however, intraoperative bleeding and postoperative neurological problem sometimes may become issues.

Aims/Objectives:
To report perioperative complications of CMEF and introduce our novel procedure to resolve these problems.

Methods:
Between 2003 and 2014, one hundred one patients with cervical radiculopathy were treated by CMEF. There were eighty three male and eighteen female, average age was 50.5 years. Intraoperative data through hospital discharge, and clinical follow-up were retrospectively analyzed. CMEF procedure was improved in 2011. New CMEF procedure includes adequate bony decompression without removing soft tissues and perineural membrane around the affected nerve root.

Results:
There were eighty two one-level procedure and nineteen two-level procedures. There were no major complication, no blood transfusions, no wound infections and no spinal cord injuries. However, 5 transient motor weakness, 10 temporary worsening of numbness, 2 allodynia and 4 dural pinholes were recognized. There were 67 traditional CMEF and 34 new CMEF. New CMEF procedure had only 2 temporary worsening of numbness and 2 dural pinholes. Total minor complication rate was 19.8%(Traditional CMEF; 23.8% , new CMEF; 11.7%), and minor neurological problem was occurred 15.8% totally, includes 20.8% in traditional CMEF and 5.8% in new CMEF. Intraoperatrive blood loss was 54.7g in traditional CMEF and 6.7g in new CMEF.

Conclusions:
In past, intraoperative bleeding and postoperative worsening of radiculopathy and/or paresthesia were sometimes issues. We have not experienced major complications. However, intraoperative bleeding control and postoperative temporally worsening of pain or numbness may sometimes become issues. We introduced new CMEF procedure to prevent intraoperative bleeding and nerve root irritation. As a result, postoperative neurological problem includes temporally worsen sensory and motor problems, and allodynia were significantly reduced from 20.8% to 5.8%. Introperative blood loss was also significantly reduced in new CMEF.