Summary
Interbody fusion after anterior discectomy may lead to acceleration of degenerative changes at adjacent levels. Although the posterior approach preserves the motion segment, decompression of the nerve root is indirect if “hard disc prolaps” is the main cause. Recently, a technique of microsurgical anterior cervical foraminotomy for the treatment of radiculopathy with preservation of the segment mobility was published. In this study, we present this technique with several modifications.
Thirteen patients – 5 men and 8 women with an average age of 49 years – with unilateral radiculopathy resistant to conservative treatment underwent microsurgical anterior foraminotomy via a small keyhole transuncal approach. The base of the uncinate process (UP) was directly drilled in the trajectory to the intervertebral foramen without destroying the disc tissue. The vertebral artery between the transverse process was not exposed. Furthermore, the functional anatomy of the uncovertebral joint remained largely intact. All patients experienced complete relief of radiating pain. A cervical collar was not used. Mean follow-up time was 19 months. The mobility of the operated segment was preserved in each patient. No instability of the cervical spine was seen.
The microsurgical anterior foraminotomy via a small keyhole transuncal approach is safe, minimally invasive, and represents an effective method to treat unilateral cervical radiculopathy caused by disc prolaps and/or uncovertebral osteophytes. Additionally, the segment mobility is preserved and prevents the acceleration of degenerative changes at adjacent levels.
Similar content being viewed by others
References
H Baba N Furusawa S Imura et al. (1993) ArticleTitleLate radiographic findings after anterior cervical fusion for spondylotic myeloradiculopathy Spine 18 2167–2173 Occurrence Handle8278827 Occurrence Handle1:STN:280:DyaK2c7gsFOrtw%3D%3D Occurrence Handle10.1097/00007632-199311000-00004
H Bertalanffy HR Eggert (1988) ArticleTitleClinical long-term results of anterior discectomy without fusion for treatment of cervical radiculopathy and meylopathy. A follow-up of 164 cases Acta Neurochir (Wien) 90 127–135 Occurrence Handle10.1007/BF01560567 Occurrence Handle1:STN:280:DyaL1c7otVCgsQ%3D%3D
TG Burke A Caputy (2000) ArticleTitleMicroendoscopic posterior cervical foraminotomy: a cadaveric model and clinical application for cervical adiculopathy J Neurosurg (Spine 1) 93 126–129 Occurrence Handle1:STN:280:DC%2BD3czjs1Witw%3D%3D
BH Chen RN Natarajan HS An et al. (2001) ArticleTitleComparison of biomechanical response to surgical procedures used for cervical radiculopathy: posterior keyhole foraminotomy versus anterior foraminotomy and discectomy versus anterior discectomy with fusion J Spinal Disord 14 17–20 Occurrence Handle11242270 Occurrence Handle10.1097/00002517-200102000-00004 Occurrence Handle1:STN:280:DC%2BD3M7nt1artg%3D%3D
TY Chen NR Crawford VK Sonntag et al. (2001) ArticleTitleBiomechanical effects of progressive anterior cervical decompression Spine 26 6–14 Occurrence Handle11148638 Occurrence Handle10.1097/00007632-200101010-00003 Occurrence Handle1:STN:280:DC%2BD3M7js1Wltg%3D%3D
JD Clausen VK Goel VC Traynelis et al. (1997) ArticleTitleUncinate process and Luschka joints influence the biomechanics of the cervical spine: quantification using a finite element model of the C5–C6 segment J Orthop Res 15 342–347 Occurrence Handle9246079 Occurrence Handle10.1002/jor.1100150305 Occurrence Handle1:STN:280:DyaK2szovVyntA%3D%3D
RB Cloward (1958) ArticleTitleThe anterior approach for removal of ruptured cervical discs J Neurosurg 15 602–614 Occurrence Handle13599052 Occurrence Handle1:STN:280:DyaG1M%2FivVCmtg%3D%3D
JF Cusick N Yoganandan F Pintar et al. (1988) ArticleTitleBiomechanics of cervical spine facetectomy and fixation techniques Spine 13 808–812 Occurrence Handle3194790 Occurrence Handle10.1097/00007632-198807000-00017 Occurrence Handle1:STN:280:DyaL1M%2FlvVOjuw%3D%3D
NA Ebraheim R Xu RA Bhatti et al. (1999) ArticleTitleThe projection of the cervical disc and uncinate process on the posterior aspect of the cervical spine Surg Neurol 51 363–367 Occurrence Handle10199287 Occurrence Handle10.1016/S0090-3019(98)00116-5 Occurrence Handle1:STN:280:DyaK1M3htlekuw%3D%3D
R Frykholm (1951) ArticleTitleLower cervical vertebrae and intervertebral discs: surgical anatomy and pathology Acta Chir Scand 101 345–359 Occurrence Handle14868335 Occurrence Handle1:STN:280:DyaG38%2FgtVGmsQ%3D%3D
J Goffin A Casey P Kehr et al. (2002) ArticleTitlePreliminary clinical experience with the Bryan Cervical Disc Prosthesis Neurosurgery 51 840–847 Occurrence Handle12188968 Occurrence Handle10.1097/00006123-200209000-00048
DR Gore SB Sepic (1984) ArticleTitleAnterior cervical fusion for degenerated or protruded discs: a review of one hundred forty-six patients Spine 9 667–671 Occurrence Handle6505833 Occurrence Handle10.1097/00007632-198410000-00002 Occurrence Handle1:STN:280:DyaL2M%2Fms1SmtA%3D%3D
PL Grundy TJ Germon SS Gill (2000) ArticleTitleTranspedicular approaches to cervical uncovertebral osteophytes causing radiculopathy J Neurosurg (Spine 1) 93 21–27 Occurrence Handle1:STN:280:DC%2BD3czjs1Wjsw%3D%3D
RJ Hacker CG Miller (2003) ArticleTitleFailed anterior cervical foraminotomy J Neurosurg (Spine 2) 98 126–130
A Hakuba (1976) ArticleTitleTrans-unco-discal approach. A combined anterior and lateral approach to cervical discs J Neurosurg 45 284–291 Occurrence Handle781189 Occurrence Handle1:STN:280:DyaE283jvFyhtA%3D%3D
CM Henderson RG Hennessy HM Shuey et al. (1983) ArticleTitlePosterior-lateral foraminotomy as an exclusive operative technique for cervical radiculopathy: a review of 846 consecutively operated cases Neurosurgery 13 504–512 Occurrence Handle6316196 Occurrence Handle1:STN:280:DyaL2c%2FmvVGisA%3D%3D
AS Hilibrand GD Carlson MA Palumbo et al. (1999) ArticleTitleRadiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis J Bone Joint Surg Am 81A 519–528
HD Jho (1996) ArticleTitleMicrosurgical anterior cervical foraminotomy for radiculopathy: a new approach to cervical disc herniation J Neurosurg 84 155–160 Occurrence Handle8592215 Occurrence Handle1:STN:280:DyaK287lt1ektQ%3D%3D Occurrence Handle10.3171/jns.1996.84.2.0155
HD Jho (2003) ArticleTitleFailed anterior cervical foraminotomy J Neurosurg (Spine 2) 98 121–125
A Jung P Kehr M Hamid (1974) ArticleTitleDie Unkoforaminektomie bei Läsionen der Arteria vertebralis und der Zervikalnervenwurzeln Z Orthop 112 736–740 Occurrence Handle4280734 Occurrence Handle1:STN:280:DyaE2M%2FoslKhsA%3D%3D
Y Kotani PS McNulty K Abumi et al. (1998) ArticleTitleThe role of anteromedial foraminotomy and the uncovertebral joints in the stability of the cervical spine a biomechanical study Spine 23 1559–1565 Occurrence Handle9682312 Occurrence Handle10.1097/00007632-199807150-00011 Occurrence Handle1:STN:280:DyaK1czkslagtg%3D%3D
J Lu NA Ebraheim H Yang et al. (1998) ArticleTitleCervical uncinate process: an anatomic study for anterior decompression of the cervical spine Surg Radiol Anat 20 249–252 Occurrence Handle9787390 Occurrence Handle1:STN:280:DyaK1M%2FgtlKmug%3D%3D
C Mosdal (1984) ArticleTitleCervical osteochondrosis and disc herniation. Eighteen years use of interbody fusion by Cloward’s technique in 755 cases Acta Neurochir (Wien) 70 207–225 Occurrence Handle10.1007/BF01406650 Occurrence Handle1:STN:280:DyaL2c7nsFequg%3D%3D
F Murphy JC Simmons B Brunson (1973) ArticleTitleSurgical treatment of laterally ruptured cervical disc. Review of 648 cases, 1939–1972 J Neurosurg 38 679–683
GL Odom W Finney B Woodhall (1958) ArticleTitleCervical disc lesions JAMA 166 23–26 Occurrence Handle1:STN:280:DyaG1c%2FjsVSmuw%3D%3D
L Penning JT Wilmink (1987) ArticleTitleRotation of the cervical spine: a CT study in normal subjects Spine 12 732–738 Occurrence Handle3686228 Occurrence Handle10.1097/00007632-198710000-00003 Occurrence Handle1:STN:280:DyaL1c%2FntV2qtg%3D%3D
J Pospiech D Stolke HJ Wilke et al. (1999) ArticleTitleIntradiscal pressure recordings in the cervical spine Neurosurgery 44 379–385 Occurrence Handle9932892 Occurrence Handle10.1097/00006123-199902000-00078 Occurrence Handle1:STN:280:DyaK1M7ivFKksA%3D%3D
RB Raynor J Pugh I Shapiro (1985) ArticleTitleCervical facetectomy and its effect on spine strength J Neurosurg 63 278–282 Occurrence Handle4020449 Occurrence Handle1:STN:280:DyaL2M3mtlynsw%3D%3D
RA Robinson GW Smith (1955) ArticleTitleAnterolateral cervical disc removal and interbody fusion for cervical disc syndrome Bull Johns Hopkins Hosp 96 223–224
WF Saringer B Reddy I Nöbauer-Huhmann et al. (2003) ArticleTitleEndoscopic anterior foraminotomy for unilateral radiculopathy: anatomical morphometric analysis and preliminary clinical experience J Neurosurg (Spine 2) 98 171–180
WB Scoville GJ Dohrmann G Corkill (1976) ArticleTitleLate results of cervical disc surgery J Neurosurg 45 203–210 Occurrence Handle939979 Occurrence Handle1:STN:280:DyaE283jvFyisw%3D%3D
H Verbiest (1968) ArticleTitleA lateral approach to the cervical spine: technique and indications J Neurosurg 28 191–203 Occurrence Handle5643912 Occurrence Handle1:STN:280:DyaF1c7pt1Wisw%3D%3D Occurrence Handle10.3171/jns.1968.28.3.0191
H Vernon S Mior (1991) ArticleTitleThe neck disability index: a study of reliability and validity J Manipulative Physiol Ther 14 409–415 Occurrence Handle1834753 Occurrence Handle1:STN:280:DyaK38%2FksVWlsg%3D%3D
RW Williams (1983) ArticleTitleMicrocervical foraminotomy. A surgical alternative for intractable radicular pain Spine 8 708–716 Occurrence Handle6320471 Occurrence Handle10.1097/00007632-198310000-00005 Occurrence Handle1:STN:280:DyaL2c7itFGntA%3D%3D
TA Zdeblick D Zou KE Warden et al. (1992) ArticleTitleCervical stability after foraminotomy. A biomechanical in vitro analysis J Bone Joint Surg (Am) 74 22–27 Occurrence Handle1:STN:280:DyaK387ivFCitw%3D%3D
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Lee, JY., Löhr, M., Impekoven, P. et al. Small keyhole transuncal foraminotomy for unilateral cervical radiculopathy. Acta Neurochir (Wien) 148, 951–958 (2006). https://doi.org/10.1007/s00701-006-0812-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00701-006-0812-7