Transvertebral anterior key hole foraminotomy without fusion for the cervicothoracic junction
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Various surgical procedures have been used to repair disc herniations and osteophytes at the cervicothoracic junction. Among these procedures, transvertebral anterior foraminotomy without fusion is a relatively less invasive, safe and useful method, although the majority of spinal surgeons remain unfamiliar with this method. We describe the surgical procedure for a transvertebral anterior keyhole foraminotomy without fusion at the cervicothoracic junction, and we assess the middle-term clinical and radiological outcomes.
Of 118 patients undergoing this surgery in our institute between 2007 and 2010, five (4.2 %) had C8 radiculopathy causing C7/T1 disc herniations or osteophytes. We studied five patients who underwent trans-C7 vertebral keyhole foraminotomy without fusion. We retrospectively examined clinical data, pre- and postoperative neurological status.
In all cases, surgical decompression was successfully achieved without difficulty when accessing the pathology. No complications related to the surgical procedure were reported. The follow-up period was 12–28 (mean 20) months. In all patients, the visual analogue scale (VAS) due to radicular pain immediately decreased after the operation and did not increase thereafter. The mean VAS decreased from 7.8 (4.5–9.6) to 1.0 (0–2.1). The Cobb angle at C2-T1 in a neutral position improved from −12.6 (−2.8 to −24.7) degrees to −6.9 (4.2 to −25.4). The postoperative C7/T1 disc height decreased from 5.4 to 4.9 mm, indicating minimal loss.
This procedure allows for direct access to the pathology and is less invasive. In this study, we clarified that this technique yields excellent radiological and clinical outcomes.
KeywordsAnterior foraminotomy without fusion C8 radiculopathy Transvertebral approach Cervical disc herniation
Disclosure of funding and the source of financial support and industry affiliations
The manuscript submitted does not contain information about medical device(s)/drug(s). No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.
Conflicts of interest
Patient placed in spine position. A 3-cm transverse skin incision was made along with the winkle. I dissected the soft tissue along with inside SCM. Just after exposing the vertebral body surface unilaterally, I injected blue dye in the C7/T1 disc level as a landmark. Right longs coli muscle was retracted laterally. A 7-mm square keyhole was made in the caudo-lateral cornar toward the C7/T1 disc level. After making the keyhole, the posterior longitudinal ligament was cut to find the dural sac and nerve root. The disc protrusion that compressed the C8 nerve root was removed. We can see that this is the C8 nerve root. Finally, we irrigated the operative field and checked secure hemostasis. The skin was sutured without drainage (MPG 13910 kb)
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