Abstract
Background
Anatomical study of the relationship among the cervical nerve roots, intervertebral disc, and lateral mass is important for the neurosurgeon to avoid complications of posterior cervical foraminotomy.
Methods
Six adult cadavers were studied. The muscles of the back of the neck were removed to expose the cervical vertebrae posteriorly from C3 to C7. We measured the length, height, extent, and angulations of the nerve roots from the medial point of the facet (MPF) after a total laminectomy, then after one-half facetectomy. The height, width, anteroposterior diameter of the lateral mass, then the height and anteroposterior diameter of the neural foramen were also measured.
Results
After total laminectomy from C3 to C7, all measures were taken from MPF showed that the mean length of the exposed root was 6.5–8.8 mm while vertical distance was 4–5.4 mm and the horizontal distance was 5.1–7.1 mm. Following a medial one-half facetectomy; the mean length of the exposed root was 8.9–12.3 mm, the vertical distance was 5.5–7.3 mm while the horizontal distance was 7.1–9.8 mm. The mean angulations of the nerve roots were 50.9–53.3º. There was a significant difference after total laminectomy and medial one-half facetectomy.
Conclusion
Anatomic and morphologic study of the cervical nerve roots and their relationships to the lateral mass and the intervertebral disc are useful landmarks to reduce the operative complications of the posterior foraminotomy.
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Abbreviations
- MPF:
-
Medial point of the facet
References
Abdullah K, Steinmetz M, Mroz T (2009) Morphometric and volumetric analysis of the lateral masses of the lower cervical spine. Spine (Phila Pa 1976) 34(14):1476–1479
Adamson T (2001) Microendoscopic posterior cervical laminoforaminotomy for unilateral radiculopathy: results of a new technique in 100 cases. J Neurosurg 95(1):51–57
Baba H, Chen Q, Uchida K, Imura S, Morikawa S, Tomita K (1996) Laminoplasty with foraminotomy for coexisting cervical myelopathy and unilateral radiculopathy: a preliminary report. Spine (Phila Pa 1976) 21(2):196–202
Burke T, Caputy A (2000) Microendoscopic posterior cervical foraminotomy: a cadaveric model and clinical application for cervical radiculopathy. J Neurosurg 93(1 Suppl):126–129
Cağlar YS, Bozkurt M, Kahilogullari G, Tuna H, Bakir A, Torun F, Ugur H (2007) Keyhole approach for posterior cervical discectomy: experience on 84 patients. Minim Invasive Neurosurg 50(1):7–11
Chen B, Natarajan R, An H, Andersson G (2001) 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 14(1):17–20
Coric D, Adamson T (2008) Minimally invasive cervical microendoscopic laminoforaminotomy. Neurosurg Focus 25(2):E2
Epstein J, Lavine L, Aronson H, Epstein B (1965) Cervical spondylotic radiculopathy. The syndrome of foraminal constriction treated by foraminotoy and the removal of osteophytes. Clin Orthop Relat Res 40:113–122
Epstein N (2009) Minimally invasive/endoscopic vs. “open” posterior cervical laminoforaminotomy: do the risks outweigh the benefits? Surg Neurol 71(3):330–331
Epstein N (2002) A review of laminoforaminotomy for the management of lateral and foraminal cervical disc herniations or spurs. Surg Neurol 57(4):226–234
Fager C (1983) Posterolateral approach to ruptured median and paramedian cervical disk. Surg Neurol 20(6):443–452
Fessler R, Khoo L (2002) Minimally invasive cervical microendoscopic foraminotomy: an initial clinical experience. Neurosurgery 51(5):S37–S45
Heary R, Ryken T, Matz P, Anderson P, Groff M, Holly L, Kaiser M, Mummaneni P, Choudhri T, Vresilovic E, Resnick D (2009) Joint section on disorders of the spine and peripheral nerves of the american association of neurological surgeons and congress of neurological surgeons cervical laminoforaminotomy for the treatment of cervical degenerative radiculopathy. J Neurosurg Spine 11(2):198–202
Hilton D (2007) Minimally invasive tubular access for posterior cervical foraminotomy with three-dimensional microscopic visualization and localization with anterior/posterior imaging. Spine J 7(2):154–158
Hwang J, Bae H, Cho S, Cho S, Park H, Chang J (2010) Morphometric study of the nerve roots around the lateral mass for posterior foraminotomy. J Korean Neurosurg Soc 47(5):358–364
Jagannathan J, Sherman J, Szabo T, Shaffrey C, Jane J (2009) 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 10(4):347–356
Krupp W, Schattke H, Müke R (1990) Clinical results of the foraminotomy as described by Frykholm for the treatment of lateral cervical disc herniation. Acta Neurochir (Wien) 107(1–2):22–29
Kumar G, Maurice-Williams R, Bradford R (1998) Cervical foraminotomy: an effective treatment for cervical spondylotic radiculopathy. Br J Neurosurg 12(6):563–568
Mixter W (1949) Rupture of the intervertebral disk; a short history of this evolution as a syndrome of importance to the surgeon. J Am Med Assoc 140(3):278–82
Raynor R, Pugh J, Shapiro I (1985) Cervical facetectomy and its effect on spine strength. J Neurosurg 63(2):278–282
Rodrigues M, Hanel R, Prevedello D, Antoniuk A, Araújo J (2001) Posterior approach for soft cervical disc herniation: a neglected technique? Surg Neurol 55(1):17–22 (discussion 22)
Roh S, Kim D, Cardoso A, Fessler R (2000) Endoscopic foraminotomy using MED system in cadaveric specimens.Spine (Phila Pa 1976) 25(2):260–4
Scoville W (1961) Cervical spondylosis treated by bilateral facetectomy and laminectomy. J Neurosurg 18:423–428
Tumialán L, Ponton R, Gluf W (2010) Management of unilateral cervical radiculopathy in the military: the cost effectiveness of posterior cervical foraminotomy compared with anterior cervical discectomy and fusion. Neurosurg Focus 28(5):E17
Winder M, Thomas K (2011) Minimally invasive versus open approach for cervical laminoforaminotomy. Can J Neurol Sci 38(2):262–267
Zdeblick T, Zou D, Warden K, McCabe R, Kunz D, Vanderby R (1992) Cervical stability after foraminotomy. A biomechanical in vitro analysis. J Bone Joint Surg Am 74(1):22–27
Zeidman S, Ducker T (1993) Posterior cervical laminoforaminotomy for radiculopathy: review of 172 cases. Neurosurgery 33(3):356–362
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Barakat, M., Hussein, Y. Anatomical study of the cervical nerve roots for posterior foraminotomy: cadaveric study. Eur Spine J 21, 1383–1388 (2012). https://doi.org/10.1007/s00586-012-2158-6
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DOI: https://doi.org/10.1007/s00586-012-2158-6