Treatment of Degenerative Cervical Disc Disease with Uncoforaminotomy – Intermediate Clinical Outcome

 

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Abstract

Background: Anterior cervical uncoforaminotomy (uncoforaminotomy) is an operative method intended to preserve the functional motion segment of the cervical spine while removing the underlying pathology. Controversy exists concerning the patients best suited for this treatment modality. Furthermore, no long-term outcome analyses have been published.

Methods: Between November 2002 and June 2004, 96 patients underwent single-level uncoforaminotomy in our neurosurgical department for the treatment of cervical radiculopathy. The patients were divided into three groups: A, soft disc; B, hard disc; C, hard and soft disc. Follow-up was performed 2 years after surgery. Clinical outcome was classified according to Odom et al. and to the cervical Oswestry and 11-point box scales for arm and neck pain.

Results: Ninety patients (92%) underwent intermediate follow-up examinations at an average of 33 months after surgery. Forty-nine patients were in group A, 24 in group B, and 17 in group C. At discharge, 98% of those in group A, 96% in group B, and 94% in group C showed excellent or good results. In two patients revision surgery was performed within 4 weeks due to recurrent disc herniation. In one patient revision was carried out due to a subcutaneous hematoma. In group B one case of vertebral artery injury occurred. Additionally in one patient of this group revision surgery was performed due to inadequate decompression of the neural foramen. At follow-up 94% of the patients in group A, 89% in group B, and 87% in group C had excellent or good results. The scores on the cervical Oswestry scale and the 11-point-box scale showed no significant differences among the groups.

Conclusion: Uncoforaminotomy, especially in patients with soft-disc pathologies, is a good operative method for the treatment of radicular pain.

References

• 1 Jho HD. Microsurgical anterior cervical foraminotomy for radiculopathy: a new approach to cervical disc herniation.  J Neurosurg. 1996;  84 155-160
  CrossrefPubMedGoogle Scholar
• 2 Hakuba A. Trans-unco-discal approach. A combined anterior and lateral approach to cervical discs.  J Neurosurg. 1976;  45 284-291
  PubMedGoogle Scholar
• 3 Verbiest H. A lateral approach to the cervical spine: technique and indications.  J Neurosurg. 1968;  28 191-203
  CrossrefPubMedGoogle Scholar
• 4 Saringer W, Nobauer I, Reddy M, Tschabitscher M, Horaczek A. Microsurgical anterior cervical foraminotomy (uncoforaminotomy) for unilateral radiculopathy: clinical results of a new technique.  Acta Neurochir (Wien). 2002;  144 685-694
  CrossrefPubMedGoogle Scholar
• 5 DePalma AF, Rothman RH, Lewinnek GE, Canale ST. Anterior interbody fusion for severe cervical disc degeneration.  Surg Gynecol Obstet. 1972;  134 755-758
  PubMedGoogle Scholar
• 6 Gore DR, Gardner GM, Sepic SB, Murray MP. Roentgenographic find-ings following anterior cervical fusion.  Skeletal Radiol. 1986;  15 556-559
  CrossrefPubMedGoogle Scholar
• 7 Hilibrand AS, Yoo JU, Carlson GD, Bohlman HH. The success of anterior cervical arthrodesis adjacent to a previous fusion.  Spine. 1997;  22 1574-1579
  CrossrefPubMedGoogle Scholar
• 8 Hunter LY, Braunstein EM, Bailey RW. Radiographic changes following anterior cervical fusion.  Spine. 1980;  5 399-401
  CrossrefPubMedGoogle Scholar
• 9 Pospiech J, Stolke D, Wilke HJ, Claes LE. Intradiscal pressure recordings in the cervical spine.  Neurosurgery. 1999;  44 379-385
  CrossrefPubMedGoogle Scholar
• 10 Jho HD. Spinal cord decompression via microsurgical anterior foraminotomy for spondylotic cervical myelopathy.  Minim Invas Neurosurg. 1997;  40 124-129
  Article in Thieme ConnectPubMedGoogle Scholar
• 11 Jho HD. Decompression via microsurgical anterior foraminotomy for cervical spondylotic myelopathy. Technical note.  J Neurosurg. 1997;  86 297-302
  CrossrefPubMedGoogle Scholar
• 12 Lu J, Ebraheim NA, Yang H, Skie M, Yeasting RA. Cervical uncinate process: an anatomic study for anterior decompression of the cervical spine.  Surg Radiol Anat. 1998;  20 249-252
  CrossrefPubMedGoogle Scholar
• 13 Tascioglu AO, Attar A, Tascioglu B. Microsurgical anterior cervical foraminotomy (uncinatectomy) for cervical disc herniation. Report of three cases.  J Neurosurg. 2001;  94 121-125
  PubMedGoogle Scholar
• 14 Jho HD. Editorial, Failed anterior cervical foraminotomy.  J Neurosurg Spine. 2003;  98 121-125
  CrossrefPubMedGoogle Scholar
• 15 Odom GL, Finney W, Woodhall B. Cervical disk lesions.  J Am Med Assoc. 1958;  166 23-28
  CrossrefPubMedGoogle Scholar
• 16 Zoega B, Karrholm J, Lind B. Outcome scores in degenerative cervical disc surgery.  Eur Spine J. 2000;  9 137-143
  CrossrefPubMedGoogle Scholar
• 17 Baba H, Furusawa N, Imura S. et al . Late radiographic findings after anterior cervical fusion for spondylotic myeloradiculopathy.  Spine. 1993;  18 2167-2173
  CrossrefPubMedGoogle Scholar
• 18 Bertalanffy H, Eggert HR. Clinical long-term results of anterior discectomy without fusion for treatment of cervical radiculopathy and myelopathy. A follow-up of 164 cases.  Acta Neurochir (Wien). 1988;  90 127-135
  CrossrefPubMedGoogle Scholar
• 19 Clements DH, O'Leary PF. Anterior cervical discectomy and fusion.  Spine. 1990;  15 1023-1025
  CrossrefPubMedGoogle Scholar
• 20 Savolainen S, Rinne J, Hernesniemi J. A prospective randomized study of anterior single-level cervical disc operations with long-term follow-up: surgical fusion is unnecessary.  Neurosurgery. 1998;  43 51-55
  PubMedGoogle Scholar
• 21 Lundsford LD, Bissonette JD, Janneta PJ. et al . Anterior surgery for cervical disc disease. Part 1: treatment of lateral cervical disc-herniation in 253 cases.  J Neurosurg. 1973;  53 679-683
  PubMedGoogle Scholar
• 22 Adamson TE. Microendoscopic posterior cervical laminoforaminotomy for unilateral radiculopathy: results of a new technique in 100 cases.  J Neurosurg Spine. 2001;  95 5157
  PubMedGoogle Scholar
• 23 Martins AN. Anterior cervical discectomy with and without interbody bone graft.  J Neurosurg. 1976;  44 290-295
  PubMedGoogle Scholar
• 24 Matge G. Anterior interbody fusion with the BAK-cage in cervical spondylosis.  Acta Neurochir (Wien). 1998;  140 1-8
  CrossrefPubMedGoogle Scholar
• 25 Murphy MG, Gado M. Anterior cervical discectomy without interbody bone graft.  J Neurosurg. 1972;  37 71-74
  PubMedGoogle Scholar
• 26 Watters  3rd  WC, Levinthal R. Anterior cervical discectomy with and without fusion. Results, complication and long-term follow-up.  Spine. 1994;  19 2343-2347
  CrossrefPubMedGoogle Scholar
• 27 Johnson JP, Filler AG, MacBride DQ. et al . Anterior cervical uncoforaminotomy for unilateral radicular disease.  Spine. 2000;  25 905-909
  CrossrefPubMedGoogle Scholar
• 28 Hacker RJ, Miller CG. Failed anterior cervical foraminotomy.  J Neurosurg. 2003;  98 126-130
  PubMedGoogle Scholar
• 29 Golfinos JG, Dickmann CA, Zabramski JM. et al . Repair of vertebral artery injury during anterior cervical decompression.  Spine. 1994;  19 2552-2556
  CrossrefPubMedGoogle Scholar
• 30 Smith MD, Emery SE, Dudley A. et al . Vertebral artery injury during anterior decompression of the cervical spine.  J Bone Joint Surg [Br]. 1993;  75 410-415
  PubMedGoogle Scholar
• 31 Thome C, Leheta O, Krauss JK, Zevgaridis D. A prospective randomized comparison of rectangular titanium cage fusion and iliac crest autograft fusion in patients undergoing anterior cervical discectomy.  J Neurosurg Spine. 2006;  4 1-9
  CrossrefPubMedGoogle Scholar
• 32 Mehren C, Suchomel P, Grochulla F. et al . Heterotopic ossification in total cervical artificial disc replacement.  Spine. 2006;  31 2802-2806
  CrossrefPubMedGoogle Scholar

Correspondence

Dr. med. I. Pechlivanis

Department of Neurosurgery

Ruhr-University Bochum

Knappschaftskrankenhaus-Bochum-Langendreer

In der Schornau 23 – 25

44780 Bochum

Germany

Phone: +49/234/299

Email: ioannis.pechlivanis@ruhr-uni-bochum.de