Anterior Decompression: Discectomy and Uncotomy–Open Technique
Anterior cervical discectomy (ACD) is still considered the gold standard treatment for compressive cervical pathology. The uncoforaminotomy performed simultaneously with ACD directly decompresses the exiting nerve root and improves radiculopathy symptoms significantly. With proper patient selection, careful preoperative planning, and meticulous intraoperative surgical technique, the incidence of complications after ACD and uncotomy can be minimized. Preoperative understanding of a particular patient’s anatomy is imperative for a safe and effective decompression. Surgeon must be aware of the course of vertebral arteries and their relation with posterior uncinates on both sides. The uncinates define the safe zone for the vertebral artery and the effective zone for the decompression. Surgeon should avoid excessive lateral drilling to avoid vertebral artery injury. Surgeon should not lose orientation to the uncinates during decompression. Kerrison rongeur must hug posterior bony margin of uncinate to avoid exiting nerve root injury and perform safe decompression.