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

  • How I Do it - Spine degenerative
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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.

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Acknowledgments

We heartily thank Pr. Selcuk Yilmazlar, Department of Neurosurgery, Uludag University (Bursa, Turkey), for permitting the reproduction of Fig. 1.

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Authors and Affiliations

  1. Neurosurgery, Clinique de Genolier, Route de Muids 3, Genolier, 1272, Switzerland

    Rodolfo Maduri & John Michael Duff

  2. Department of Orthopedics, Spine Unit, University Hospital of Umeå, Umeå, Sweden

    Lukas Bobinski

Authors
  1. Rodolfo Maduri
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  2. Lukas Bobinski
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  3. John Michael Duff
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Corresponding author

Correspondence to Rodolfo Maduri.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors

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Key Points

1) Single-level cervical radiculopathy may be treated with ACF.

2) Careful preoperative neurological and radiological investigations are mandatory.

3) The course of VA needs to be studied on preoperative imaging.

4) The use and careful placement of tubular retractors may help preventing VA injury and excessive bone removal by guiding drilling trajectory.

5) Identification of bony landmarks intraoperatively is crucial.

6) Anterior foraminotomy permits a direct “tailored” foraminal decompression.

7) The UP is removed only on its posterior half.

8) “Tailored” bone removal prevents iatrogenic instability.

9) Removal of disc fragments and osteophytes decompresses the nerve root.

10) Postoperative follow-up is mandatory.

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Maduri, R., Bobinski, L. & Duff, J.M. Minimally invasive anterior foraminotomy for cervical radiculopathy: how I do it. Acta Neurochir 162, 679–683 (2020). https://doi.org/10.1007/s00701-019-04201-y

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  • DOI: https://doi.org/10.1007/s00701-019-04201-y

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