Top

Acta Neurochirurgica

Published in:

01-03-2020 | Disc Herniation | How I Do it - Spine degenerative

Minimally invasive anterior foraminotomy for cervical radiculopathy: how I do it

Authors: Rodolfo Maduri, Lukas Bobinski, John Michael Duff

Published in: Acta Neurochirurgica | Issue 3/2020

Abstract

Background

The standard treatment for cervical radiculopathy is anterior discectomy and fusion. The authors describe a minimally invasive anterior cervical foraminotomy as a surgical option for direct nerve root decompression in cervical radiculopathy.

Method

Through a modified Smith-Robinson approach, the prevertebral fascia is mobilized laterally, displacing the sympathetic chain with it. A thumbnail size portion of the longus colli muscle is removed. A tubular retractor is placed, centered over the index uncovertebral joint. The lateral part of the joint is progressively drilled towards the foramen. After exposure of the intervertebral foramen, the perivascular ligamentous tissue is opened. Removal of disc fragments and osteophytes allows direct visualization and direct decompression of the nerve root.

Conclusion

Anterior cervical foraminotomy is a safe “motion preserving” procedure for direct nerve decompression in selected patients with cervical radiculopathy that does not require cervical fusion.

Available only for authorised users

Hacker RJ, Miller CG (2003) Failed anterior cervical foraminotomy. J Neurosurg 98:126–130PubMed

Hartman J (2014) Anatomy and clinical significance of the uncinate process and uncovertebral joint: a comprehensive review. Clin Anat 27:431–440. https://doi.org/10.1002/ca.22317 CrossRefPubMed

Jho HD (1996) Microsurgical anterior cervical foraminotomy for radiculopathy: a new approach to cervical disc herniation. J Neurosurg 84:155–160. https://doi.org/10.3171/jns.1996.84.2.0155 CrossRefPubMed

Jho HD (2003) Failed anterior cervical foraminotomy. J Neurosurg 98:121–125 discussion 125PubMed

Jho HD, Kim WK, Kim MH (2002) Anterior microforaminotomy for treatment of cervical radiculopathy: part 1--disc-preserving “functional cervical disc surgery”. Neurosurgery 51:S46–S53PubMed

Nguyen J, Chu B, Kuo CC, Leasure JM, Ames C, Kondrashov D (2017) Changes in foraminal area with anterior decompression versus keyhole foraminotomy in the cervical spine: a biomechanical investigation. J Neurosurg Spine 27:620–626. https://doi.org/10.3171/2017.2.SPINE141237 CrossRefPubMed

Pait TG, Killefer JA, Arnautovic KI (1996) Surgical anatomy of the anterior cervical spine: the disc space, vertebral artery, and associated bony structures. Neurosurgery 39:769–776. https://doi.org/10.1097/00006123-199610000-00026 CrossRefPubMed

Park YK, Moon HJ, Kwon TH, Kim JH (2013) Long-term outcomes following anterior foraminotomy for one- or two-level cervical radiculopathy. Eur Spine J 22:1489–1496. https://doi.org/10.1007/s00586-013-2712-x CrossRefPubMedPubMedCentral

Yilmazlar S, Kocaeli H, Uz A, Tekdemir I (2003) Clinical importance of ligamentous and osseous structures in the cervical uncovertebral foraminal region. Clin Anat 16:404–410. https://doi.org/10.1002/ca.10158 CrossRefPubMed

10.

Zou S, Gao J, Xu B, Lu X, Han Y, Meng H (2017) Anterior cervical discectomy and fusion (ACDF) versus cervical disc arthroplasty (CDA) for two contiguous levels cervical disc degenerative disease: a meta-analysis of randomized controlled trials. Eur Spine J 26:985–997. https://doi.org/10.1007/s00586-016-4655-5 CrossRefPubMed

Title: Minimally invasive anterior foraminotomy for cervical radiculopathy: how I do it
Authors: Rodolfo Maduri
Lukas Bobinski
John Michael Duff
Publication date: 01-03-2020
Publisher: Springer Vienna
Keyword: Disc Herniation
Published in: Acta Neurochirurgica / Issue 3/2020
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-019-04201-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Minimally invasive anterior foraminotomy for cervical radiculopathy: how I do it

Abstract

Background

Method

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Method

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2020

Efficacy and safety of middle meningeal artery embolization in the management of refractory or chronic subdural hematomas: a systematic review and meta-analysis

Detection of spreading depolarizations in a middle cerebral artery occlusion model in swine

EANS Basic Brain Course (ABC): combining simulation to cadaver lab for a new concept of neurosurgical training

Efficacy of simultaneous pericranial and nasoseptal “double flap” reconstruction of anterior skull base defects after combined transbasal and endoscopic endonasal approaches

Endoscopic posterior cervical foraminotomy via a single stab incision for contiguous two-level cervical radiculopathy

Surgery for herniated lumbar disc in private vs public hospitals: A pragmatic comparative effectiveness study