Key points
1. The anatomy of the vertebral artery should be carefully studied at preoperative imaging
2. The patient should be in a prone position with the head fixed in a Mayfield head holder.
3. 3D navigation may be used to plan the incision and the position of tubular retractors, as well as to define intraoperatively the extent of decompression. However, the procedure can also be safely performed under standard radioscopy control
4. The use of tubular retractors limits the dissection of the paraspinal musculature and thus the local pain. Also, the functional recovery is enhanced.
5. The use of a tubular retractor of 16 mm is generally enough to allow a good exposure and ensure a satisfying decompression
6. The microscopic view allows the correct identification of the different structures and the safe performance of the procedure
7. Only the medial third of the facet joint should be drilled to avoid postoperative long-term risks of mechanical instability
8. The copious venous bleeding secondary to the exposure of the epidural venous plexus may be easily managed with positional measures, local hemostatic material, and mechanical compression.
9. Once the dura and the concerned nerve root are visualized, the foraminotomy should be enlarged with Kerrison rongeurs, and the extent of the decompression should be checked with curettes or crochets
10. If a disc fragment is present, the root can be gently displaced medially and cranially to removed it with the aid of small rongeurs.
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This article is part of the Topical Collection on Spine - Other