Klinisch funktionelle Nachuntersuchung bei zervikalem Wurzelkompressionssyndrom nach dorsaler Foraminotomie nach Frykholm und Scoville

Background: Cervical radiculopathy is to be defined as the irritation or compression of cervical nerve roots. The main reason for the mechanical compression of the cervical nerve roots is a degenerative process of the intervertebral disc with lateral herniation or the bony narrowing of the foramen due to spondylophytes onto the vertebral body and spondylarthropathies. Neck, shoulder and arm pain come along with the cervical radiculopathy syndrome that are likely to be accompanied by paralyses and/or paraesthesia of the upper extremities. Due to these facts, the cervical radiculopathy has fundamental effects on the life quality of those affected. There are numerous treatment approaches for patients suffering cervical radiculopathy. Next to the conservative therapy there are a couple of operational measures. The dorsal foraminotomy (Frykholm and Scoville) is one of the operative methods in order to decompress radicular nerve damage in cases of lateral osteophytes or lateral herniated discs. Methods: The aim of this paper is the inquiry of the clinically functional outcomes after a dorsal foraminotomy (Frykholm and Scoville) of patients with a cervical radiculopathy. Furthermore, it is one of the main aims to increase the life quality of the patients. In particular there is a focus on the pain treatment and the improvement of motoric deficits and especially on the effect of everyday life. The data is based on a survey dealing with the overall contentedness of the patients, the acquisition of pain, based on the visual analogue scale and the acquisition of the outcomes on everyday life by means of the neck pain and disability index. Additionally, a clinical examination was conducted with the focus on motion restrictions of the cervical spine, paresis of the upper extremities and sensibility disorder. As an indicator for a foramen stenosis, the HWS distraction test and the Spurling test were conducted. Results: 38 patients who underwent a dorsal foraminotomy (Frykholm and Scoville) at the “Wirbelsäulenzentrum Marburg” in the years between 2003-2008 were interviewed and analyzed on average 67,5 months after the surgery. An improvement of the pain was to be analyzed at the follow-up examination. The usage of painkillers decreased and the value on the VAS scale also decreased. Even motoric disorders at the upper extremities increased. However, enormous impairments in terms of the HWS distraction were to be seen at the follow-up examination (89,47% of the patients). The deviation towards the standard was significant. The satisfaction factor of the patients was at 7,5/10 on average. The value of the NPAD index showed up to be significant for the satisfaction of the patients. Conclusion: Altogether, a worse outcome as in comparable surveys was to be seen in this paper. The time period until the follow-up is way bigger in this survey than in others. The comparison of literature dealing with this aspect shows a tendency towards a worse outcome if the time period between operation and follow-up is further extended. This leads to the conclusion that an ongoing degenerative process could possibly deteriorate the outcome of the operation in the course of time. However, in terms of the reduction of pain, a success can be testified on average 65 month after the operation.