Minim Invasive Neurosurg 2006; 49(1): 37-42
DOI: 10.1055/s-2006-932146
Original Article
© Georg Thieme Verlag Stuttgart · New York

Modified Cervical Laminoforaminotomy Based on Anatomic Landmarks Reduces Need for Bony Removal

E.  Gadelha Figueiredo1 , M.  Castillo De La Cruz1 , N.  Theodore1 , P.  Deshmukh1 , M.  C.  Preul1
  • 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
Further Information

Publication History

Publication Date:
20 March 2006 (online)

Abstract

We describe a modified keyhole laminoforaminotomy (LF) using anatomic landmarks on the posterior aspect of the cervical vertebral body to decompress the intervertebral foramen with minimal bone removal. Twenty-four procedures were performed at C3 - 4, C4 - 5, and C5 - 6; 12 at C6 - 7; and 3 at C7 - Tl. Facets and laminae structures were identified based on relative surgical perspectives. Bony resection was limited as follows: 1) inferior limit; inferior border of the superior facet; 2) superior limit, superior border of the superior facet; 3) lateral limit, a vertical line linking the junction of the lamina-facet to the lateral end of the superior limit; and 4) lateral aspect of the dural sac. Fluoroscopy was used to confirm that the intervertebral space was reached. The amount of bony removal was quantified for the superior and inferior laminae and facets. The length of the exposed nerve root was measured. The intervertebral foramen was exposed and the intervertebral disc reached in all specimens. Fluoroscopy showed that the center of the exposure remained at the same height with the intervertebral space. The mean length of the nerve root was 4.6 mm; the mean percentage of bony resection was 21.8 %, 7.5 %, 11.3 %, and 11.5 % for the superior and inferior laminae and facets, respectively. Opening the intervertebral foramen posteriorly consistently exposed sufficient nerve root length and allowed access to the intervertebral disc. The technique offers the most direct and safest method of decompressing the intervertebral foramen while minimizing bony resection. This simple surgical procedure may help reduce postoperative morbidity.

References

  • 1 Henderson C M, Hennessy R G, Shuey Jr H M, Shackelford E G. Posterior-lateral foraminotomy as an exclusive operative technique for cervical radiculopathy: a review of 846 consecutively operated cases.  Neurosurgery. 1983;  13 504-512
  • 2 Ebraheim N A, Xu R, Bhatti R A, Yeasting R A. The projection of the cervical disc and uncinate process on the posterior aspect of the cervical spine.  Surg Neurol. 1999;  51 363-367
  • 3 Raynor R B, Pugh J, Shapiro I. Cervical facetectomy and its effect on spine strength.  J Neurosurg. 1985;  63 278-282
  • 4 Raynor R B. Anterior or posterior approach to the cervical spine: an anatomical and radiographic evaluation and comparison.  Neurosurgery. 1983;  12 7-13
  • 5 Aldrich F. Posterolateral microdiscectomy for cervical monoradiculopathy caused by posterolateral soft cervical disc sequestration.  J Neurosurg. 1990;  72 370-377
  • 6 Ducker T B, Zeidman S M. The posterior operative approach for cervical radiculopathy.  Neurosurg Clin N Am. 1993;  4 61-74
  • 7 Epstein N E. A review of laminoforaminotomy for the management of lateral and foraminal cervical disc herniations or spurs.  Surg Neurol. 2002;  57 226-233
  • 8 Rock J P, Ausman J I. The use of the operating microscope for cervical foraminotomy.  Spine. 1991;  16 1381-1383
  • 9 Rodrigues M A, Hanel R A, Prevedello D M, Antoniuk A, Araujo J C. Posterior approach for soft cervical disc herniation: a neglected technique?.  Surg Neurol. 2001;  55 17-22
  • 10 Scoville W B, Dohrmann G J, Corkill G. Late results of cervical disc surgery.  J Neurosurg. 1976;  45 203-210
  • 11 Tomaras C R, Blacklock J B, Parker W D, Harper R L. Outpatient surgical treatment of cervical radiculopathy.  J Neurosurg. 1997;  87 41-43
  • 12 Witzmann A, Hejazi N, Krasznai L. Posterior cervical foraminotomy. A follow-up study of 67 surgically treated patients with compressive radiculopathy.  Neurosurg Rev. 2000;  23 213-217
  • 13 Woertgen C, Holzschuh M, Rothoerl R D, Haeusler E, Brawanski A. Prognostic factors of posterior cervical disc surgery: a prospective, consecutive study of 54 patients.  Neurosurgery. 1997;  40 724-728
  • 14 Fager C A. Management of cervical disc lesions and spondylosis by posterior approaches.  Clin Neurosurg. 1977;  24 488-507
  • 15 Harrop J S, Silva M T, Sharan A D, Dante S J, Simeone F A. Cervicothoracic radiculopathy treated using posterior cervical foraminotomy/discectomy.  J Neurosurg Spine. 2003;  98 131-136
  • 16 Cusick J F, Yoganandan N, Pintar F, Myklebust J, Hussain H. Biomechanics of cervical spine facetectomy and fixation techniques.  Spine. 1988;  13 808-812
  • 17 Tanaka N, Fujimoto Y, An H S, Ikuta Y, Yasuda M. The anatomic relation among the nerve roots, intervertebral foramina, and intervertebral discs of the cervical spine.  Spine. 2000;  25 286-291
  • 18 Xu R, Kang A, Ebraheim N A, Yeasting R A. Anatomic relation between the cervical pedicle and the adjacent neural structures.  Spine. 1999;  24 451-454

Mark C. Preul,M. D. 

Newsome Chairman of Neurosurgery Research · Barrow Neurological Institute · Division of Neurosurgery · St. Joseph's Hospital and Medical Center

350 West Thomas Road

Phoenix, AZ 85013

USA

Fax: +1/602/406-4153

Email: mpreul@cox.net; mark.preul@chw.edu