Posterior ‘Motion Preserving’ Procedures (Frykholm)

  • Florian RingelEmail author
  • Angelika Gutenberg


Cervical radiculopathy from degenerative disease is a common problem with an incidence of 0.83–1.79 per 1000 person years. It can be caused by a cervical disc herniation, bony foraminal stenosis or spinal canal stenosis. Upon failure of conservative therapy or a significant motor deficit surgical treatment is indicated. A posterior cervical foraminotomy is one surgical option for the treatment of selected patients with lateral cervical disc herniations.


  1. 1.
    Barakat M, Hussein Y. Anatomical study of the cervical nerve roots for posterior foraminotomy: cadaveric study. Eur Spine J. 2012;21(7):1383–8.CrossRefGoogle Scholar
  2. 2.
    Bydon M, Mathios D, Macki M, de la Garza-Ramos R, Sciubba DM, Witham TF, Wolinsky JP, Gokaslan ZL, Bydon A. Long-term patient outcomes after posterior cervical foraminotomy: an analysis of 151 cases. J Neurosurg Spine. 2014;21(5):727–31.CrossRefGoogle Scholar
  3. 3.
    Carette S, Fehlings MG. Clinical practice. Cervical radiculopathy. N Engl J Med. 2005;353(4):392–9.CrossRefGoogle Scholar
  4. 4.
    Chen BH, Natarajan RN, An HS, Andersson GB. Comparison of biomechanical response to surgical procedures used for cervical radiculopathy: posterior keyhole foraminotomy versus anterior foraminotomy and discectomy versus anterior discectomy with fusion. J Spinal Disord. 2001;14(1):17–20.CrossRefGoogle Scholar
  5. 5.
    Choi KC, Ahn Y, Kang BU, Ahn ST, Lee SH. Motor palsy after posterior cervical foraminotomy: anatomical consideration. World Neurosurg. 2013;79(2):405 e401–4.CrossRefGoogle Scholar
  6. 6.
    Clarke MJ, Ecker RD, Krauss WE, McClelland RL, Dekutoski MB. Same-segment and adjacent-segment disease following posterior cervical foraminotomy. J Neurosurg Spine. 2007;6(1):5–9.CrossRefGoogle Scholar
  7. 7.
    Dohrmann GJ, Hsieh JC. Long-term results of anterior versus posterior operations for herniated cervical discs: analysis of 6,000 patients. Med Princ Pract. 2014;23(1):70–3.CrossRefGoogle Scholar
  8. 8.
    Engquist M, Lofgren H, Oberg B, Holtz A, Peolsson A, Soderlund A, Vavruch L, Lind B. Surgery versus nonsurgical treatment of cervical radiculopathy: a prospective, randomized study comparing surgery plus physiotherapy with physiotherapy alone with a 2-year follow-up. Spine (Phila Pa 1976). 2013;38(20):1715–22.CrossRefGoogle Scholar
  9. 9.
    Faught RW, Church EW, Halpern CH, Balmuri U, Attiah MA, Stein SC, Dante SJ, Welch WC, Simeone FA. Long-term quality of life after posterior cervical foraminotomy for radiculopathy. Clin Neurol Neurosurg. 2016;142:22–5.CrossRefGoogle Scholar
  10. 10.
    Gu BS, Park JH, Seong HY, Jung SK, Roh SW. Feasibility of posterior cervical foraminotomy in cervical foraminal stenosis: prediction of surgical outcomes by the foraminal shape on preoperative computed tomography. Spine (Phila Pa 1976). 2017;42(5):E267–71.CrossRefGoogle Scholar
  11. 11.
    Heckmann JG, Lang CJ, Zobelein I, Laumer R, Druschky A, Neundorfer B. Herniated cervical intervertebral discs with radiculopathy: an outcome study of conservatively or surgically treated patients. J Spinal Disord. 1999;12(5):396–401.CrossRefGoogle Scholar
  12. 12.
    Jagannathan J, Sherman JH, Szabo T, Shaffrey CI, Jane JA. The posterior cervical foraminotomy in the treatment of cervical disc/osteophyte disease: a single-surgeon experience with a minimum of 5 years’ clinical and radiographic follow-up. J Neurosurg Spine. 2009;10(4):347–56.CrossRefGoogle Scholar
  13. 13.
    Lee SB, Cho KS. Cervical arthroplasty versus anterior cervical fusion for symptomatic adjacent segment disease after anterior cervical fusion surgery: review of treatment in 41 patients. Clin Neurol Neurosurg. 2017;162:59–66.CrossRefGoogle Scholar
  14. 14.
    Liu WJ, Hu L, Chou PH, Wang JW, Kan WS. Comparison of anterior cervical discectomy and fusion versus posterior cervical foraminotomy in the treatment of cervical radiculopathy: a systematic review. Orthop Surg. 2016;8(4):425–31.CrossRefGoogle Scholar
  15. 15.
    Lubelski D, Healy AT, Silverstein MP, Abdullah KG, Thompson NR, Riew KD, Steinmetz MP, Benzel EC, Mroz TE. Reoperation rates after anterior cervical discectomy and fusion versus posterior cervical foraminotomy: a propensity-matched analysis. Spine J. 2015;15(6):1277–83.CrossRefGoogle Scholar
  16. 16.
    Persson LC, Carlsson CA, Carlsson JY. Long-lasting cervical radicular pain managed with surgery, physiotherapy, or a cervical collar. A prospective, randomized study. Spine (Phila Pa 1976). 1997;22(7):751–8.CrossRefGoogle Scholar
  17. 17.
    Roh SW, Kim DH, Cardoso AC, Fessler RG. Endoscopic foraminotomy using MED system in cadaveric specimens. Spine (Phila Pa 1976). 2000;25(2):260–4.CrossRefGoogle Scholar
  18. 18.
    Sampath P, Bendebba M, Davis JD, Ducker T. Outcome in patients with cervical radiculopathy. Prospective, multicenter study with independent clinical review. Spine (Phila Pa 1976). 1999;24(6):591–7.CrossRefGoogle Scholar
  19. 19.
    Steinberg JA, German JW. The effect of minimally invasive posterior cervical approaches versus open anterior approaches on neck pain and disability. Int J Spine Surg. 2012;6:55–61.CrossRefGoogle Scholar
  20. 20.
    Thoomes EJ, Scholten-Peeters W, Koes B, Falla D, Verhagen AP. The effectiveness of conservative treatment for patients with cervical radiculopathy: a systematic review. Clin J Pain. 2013;29(12):1073–86.CrossRefGoogle Scholar
  21. 21.
    Ulrich C, Woersdoerfer O, Kalff R, Claes L, Wilke HJ. Biomechanics of fixation systems to the cervical spine. Spine (Phila Pa 1976). 1991;16(3 Suppl):S4–9.CrossRefGoogle Scholar
  22. 22.
    van Geest S, Kuijper B, Oterdoom M, van den Hout W, Brand R, Stijnen T, Assendelft P, Koes B, Jacobs W, Peul W, Vleggeert-Lankamp C. CASINO: surgical or nonsurgical treatment for cervical radiculopathy, a randomised controlled trial. BMC Musculoskelet Disord. 2014;15:129.CrossRefGoogle Scholar
  23. 23.
    Wang TY, Lubelski D, Abdullah KG, Steinmetz MP, Benzel EC, Mroz TE. Rates of anterior cervical discectomy and fusion after initial posterior cervical foraminotomy. Spine J. 2015;15(5):971–6.CrossRefGoogle Scholar
  24. 24.
    Yoo HJ, Park JH, Seong HY, Roh SW. Comparison of surgical results between soft ruptured disc and foraminal stenosis patients in posterior cervical laminoforaminotomy. Korean J Neurotrauma. 2017;13(2):124–9.CrossRefGoogle Scholar
  25. 25.
    Zdeblick TA, Zou D, Warden KE, McCabe R, Kunz D, Vanderby R. Cervical stability after foraminotomy. A biomechanical in vitro analysis. J Bone Joint Surg Am. 1992;74(1):22–7.CrossRefGoogle Scholar
  26. 26.
    Mansfield HE, Canar WJ, Gerard CS, O’Toole JE. Single-level anterior cervical discectomy and fusion versus minimally invasive posterior cervicalforaminotomy for patients with cervical radiculopathy: a cost analysis. Neurosurg Focus. 2014;37(5):E9.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of NeurosurgeryUniversitätsmedizin Mainz, Johannes Gutenberg Universität MainzMainzGermany

Personalised recommendations