Anterior Cervical Foraminotomy for Unilateral Spondylotic Radiculopathy

Abstract

Anterior cervical foraminotomy (ACF) was developed under the concept of functional spine surgery, which directly eliminates compressive pathological factors while preserving functional anatomic features. The authors reviewed their results to determine the efficacy of the approach for unilateral cervical spondylotic radiculopathy (CSR). Nineteen patients were treated with the ACF with a follow-up from 12 to 36 months. There were 10 men and 9 women (mean age 49.8). Fourteen patients had a single ACF, and 5 had procedures at adjacent levels. The procedure involves microsurgical removal of the lateral portion of the uncinate process to identify the nerve root. Seventeen patients (89.5 %) were symptom-free or clearly improved, one (5.3 %) was unchanged and one patient (5.3 %) was worse in the visual analogue scale (VAS) score for radicular pain. One patient had developed contralateral foraminal stenosis at the level of the surgery and had undergone anterior discectomy and fusion. ACF provided good or excellent outcomes, with minimal morbidities, for patients with CSR. The advantages of ACF include direct decompression of the nerve root, and the preservation of the intervertebral disc and the motion segment. Thus, fusion-related sequelae, including graft-related complications, graft site complications and the adjacent level disease are avoided. The ACF procedure appears to be a good alternative for carefully selected patients with unilateral CSR.

Cervical spondylotic radiculopathy - anterior cervical foraminotomy

References

• 1 Fager C A. Results of adequate posterior decompression in the relief of spondylotic cervical myelopathy.  J Neurosurg. 1973;  38 684-692
• 2 Fessler R G, Steck J C, Giovanini M A. Anterior cervical corpectomy for cervical spondylotic myelopathy.  Neurosurgery. 1998;  43 257-265
• 3 Lee T T, Manzano G R, Green B A. Modified open-door cervical expansive laminoplasty for spondylotic myelopathy: operative technique, outcome, and predictors for gait improvement.  J Neurosurg. 1997;  86 64-68
• 4 Wada E, Suzuki S, Kanazawa A, Matsuoka T, Miyamoto S, Yonenobu K. Subtotal corpectomy versus laminoplasty for multilevel cervical spondylotic myelopathy: a long-term follow-up study over 10 years.  Spine. 2001;  26 1443-1447
• 5 Jho H D. Decompression via microsurgical anterior foraminotomy for cervical spondylotic myelopathy. Technical note.  J Neurosurg. 1997;  86 297-302
• 6 Jho H D. Microsurgical anterior cervical foraminotomy for radiculopathy: a new approach to cervical disc herniation.  J Neurosurg. 1996;  84 155-160
• 7 Jho H D. Spinal cord decompression via microsurgical anterior foraminotomy for spondylotic cervical myelopathy.  Minim Invas Neurosurg. 1997;  40 124-129
• 8 Jho H D, Kim W K, Kim M H. Anterior microforaminotomy for treatment of cervical radiculopathy: part 1-disc-preserving ‘functional cervical disc surgery’.  Neurosurgery. 2002;  51 (Suppl 2) 46-53
• 9 Jho H D, Kim M H, Kim W K. Anterior cervical microforaminotomy for spondylotic cervical myelopathy: part 2.  Neurosurgery. 2002;  51 (Suppl 2) 54-59
• 10 White 3rd A A, Johnson R M, Panjabi M M, Southwick W O. Biomechanical analysis of clinical stability in the cervical spine.  Clin Orthop. 1975;  109 85-96
• 11 Johnson J P, Filler A G, McBride D Q, Batzdorf U. Anterior cervical foraminotomy for unilateral radicular disease.  Spine. 2000;  25 905-909
• 12 Hacker R J, Miller C G. Failed anterior cervical foraminotomy.  J Neurosurg. 2003;  98 (Suppl 2) 126-130
• 13 Kotani Y, McNulty P S, Abumi K, Cunningham B W, Kaneda K, McAfee P C. The role of anteromedial foraminotomy and the uncovertebral joints in the stability of the cervical spine. A biomechanical study.  Spine. 1998;  23 1559-1565
• 14 George B, Gauthier N, Lot G. Multisegmental cervical spondylotic myelopathy and radiculopathy treated by multilevel oblique corpectomies without fusion.  Neurosurgery. 1999;  44 81-90
• 15 George B, Lot G. Oblique transcorporeal drilling to treat anterior compression of the spinal cord at the cervical level.  Minim Invas Neurosurg. 1994;  37 48-52
• 16 George B, Zerah M, Lot G, Hurth M. Oblique transcorporeal approach to anteriorly located lesions in the cervical spinal canal.  Acta Neurochir (Wien). 1993;  121 187-190
• 17 Jho H D. Failed anterior cervical foraminotomy.  J Neurosurg. 2003;  98 (Suppl 2) 121-125