Anterior Cervical Microforaminotomy for Cervical Radiculopathy – Results and Review

Abstract

Analysis of anterior cervical microforaminotomy performed at the North Staffordshire University Hospital along with a review of literature of this minimally invasive procedure is presented.

Methods: A retrospective – prospective study was performed on 34 patients (24 males, 10 females) with cervical disc disease who had been surgically treated with anterior cervical microforaminotomy between 1999 and 2005. Age ranged from 37 to 75. MRI findings were disc prolapse in 28 and additional osteophytes in six. Microforaminotomy was performed according to the published technique.

Results: Single level operations were performed in 22 patients (21 unilateral, 1 bilateral) and multi-level operations were performed in 12 patients (7 unilateral and 5 bilateral). The short-term outcomes were excellent in 65 % (i.e., complete resolution of all symptoms), good in 29 % (relief of radiculopathy but some non-radicular discomfort persists), and fair in 6 % (mild residual radiculopathy with or without non-radicular symptoms). Postoperative complications include one patient with partial C6 root damage, which was identified intraoperatively, but had excellent results at 2 months post operation. Long-term follow-up (using the cervical spine research society questionnaire) ranged from 2–48 months. The average pain score, neurological outcome and functional outcome improved after this operation.

Re-operation: One patient, who had 2 level bilateral surgeries, needed discectomies with fusion for new onset myelopathy 18 months later.

Conclusion: Appropriate patient selection is cardinal in achieving good outcome in anterior microforaminotomy.

Key words

anterior cervical microforaminotomy - cervical disc prolapse - cervical foraminotomy - cervical spine - intervertebral disc - radiculopathy - functional spine surgery - disc preserving surgery

References

• 1 Sampath P, Bendebba M, Davis JD. et al . Outcome in patients with cervical radiculopathy: Prospective, multicenter study with independent clinical review.  Spine. 1999;  24 591-597
• 2 Jho HD. Failed anterior cervical foraminotomy.  J Neurosurg. 2003;  98 ((2 Suppl)) 121-125; , discussion 125
• 3 Jho HD, Kim WK, Kim MH. Anterior microforaminotomy for treatment of cervical radiculopathy: Part 1–Disc-preserving “functional cervical disc surgery”.  Neurosurgery. 2002;  51 46-53
• 4 Russel SM, Benjamin V. Posterior surgical approach to the cervical neural foramen for intervertebral disc disease.  Neurosurgery. 2004;  54 662-666
• 5 Sonntag VKH, Han PP, Vishteh AG. Anterior cervical discectomy.  Neurosurgery. 2004;  49 909-912
• 6 Verbiest H. A lateral approach to the cervical spine: technique and indications.  J Neurosurg. 1968;  28 191-203
• 7 Hakuba A. Trans-unco-discal approach. A combined anterior and lateral approach to cervical discs.  J Neurosurg. 1976;  45 284-291
• 8 Chen BH, Natarajan RN, An HS. et al . Comparison 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. 2001;  14 17-20
• 9 Jho HD. Microsurgical anterior cervical foraminotomy for radiculopathy: a new approach to cervical disc herniation.  J Neurosurg. 1996;  84 155-160
• 10 Koc RK, Menku A, Tucer B. et al . Anterior cervical foraminotomy for unilateral spondylotic radiculopathy.  Minim Invas Neurosurg. 2004;  47 186-189
• 11 Saringer W, Nobauer I, Reddy M. et al . Microsurgical anterior cervical foraminotomy (uncoforaminotomy) for unilateral radiculopathy: clinical results of a new technique.  Acta Neurochir (Wien). 2002;  144 685-694
• 12 Bruneau M, Cornelius JF, George B. Microsurgical cervical nerve root decompression by anterolateral approach.  Neurosurgery. 2006;  58 ((1)) , Operative Neurosurgery Supplement 1: ONS-108-ONS-113
• 13 Hacker RJ, Miller CG. Failed anterior cervical foraminotomy.  J Neurosurg. 2003;  98 ((2 Suppl)) 126-130
• 14 de los Reyes RA, Moser FG, Sachs DP, Boehm FH. Direct repair of an extracranial vertebral artery pseudoaneurysm: case report and review of the literature.  Neurosurgery. 1990;  26 528-533
• 15 Pfeifer BA, Freidberg SR, Jewell ER. Repair of injured vertebral artery in anterior cervical procedures.  Spine. 1994;  19 1471-1474
• 16 Smith MD, Emery SE, Dudley A. et al . Vertebral artery injury during anterior decompression of the cervical spine. A retrospective review of ten patients.  J Bone Joint Surg [Br]. 1993;  75 410-415
• 17 Ebraheim NA, Lu J, Yang H. et al . Vulnerability of the sympathetic trunk during the anterior approach to the lower cervical spine.  Spine. 2000;  25 1603-1606
• 18 Chen TY, Crawford NR, Sonntag VK. et al . Biomechanical effects of progressive anterior cervical decompression.  Spine. 2001;  26 6-14
• 19 Clausen JD, Goel VK, Traynelis VC. et al . Uncinate processes and Luschka joints influence the biomechanics of the cervical spine: quantification using a finite element model of the C5-C6 segment.  J Orthop Res. 1997;  15 342-347
• 20 Lu J, Ebraheim NA, Nadim Y. et al . Anterior approach to the cervical spine: surgical anatomy.  Orthopedics. 2000;  23 841-845
• 21 Golfinos JG, Dickman CA, Zabramski JM. et al . Repair of vertebral artery injury during anterior cervical decompression.  Spine. 1994;  19 2552-2556
• 22 Guigui P, Benoist M, Deburge A. Spinal deformity and instability after multilevel cervical laminectomy for spondylotic myelopathy.  Spine. 1998;  23 440-447
• 23 Johnson JP, Filler AG, MacBride DQ, Batzdorf U. Anterior cervical foraminotomy for unilateral radicular disease.  Spine. 2000;  15; 25(8) 905-909

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