Anterior Cervical Foraminotomy

Abstract

Anterior cervical discectomy employing an interbody cage/bone graft or prosthesis is the standard operative technique for treatment of patients with cervical radiculopathy. With anterior fusion the consequent loss of motion gives concern from accelerated degeneration of nearby discs. Use of an artificial disc increases the cost of surgery, will likely fuse in the longer term and gives a risk of wear debris. Radiculopathy from lumbar disc prolapse is normally treated by a microdiscectomy leaving the remainder of the disc intact and neither performing routine fusion nor artificial disc replacement. In patients with root compression from cervical disc prolapse or bony osteophytes, the majority have pathology either in the anterolateral spinal canal or foramen. The aim of this chapter is to enable the surgical reader to understand the steps and anatomical considerations in performing an anterior cervical foraminotomy. It is strongly recommended before undertaking such surgery that a surgeon also undergo appropriate pre-procedure training such as in a cadaveric workshop.