Anterior Cervical Microforaminotomy in the Treatment of Unilateral Monosegmental Radiculopathy (a Prospective Pilot Study Involving 15 Patients)

Czech version

Authors: P. Vaněk
Authors‘ workplace: Neurochirurgická klinika 1. LF UK a ÚVN Praha
Published in: Cesk Slov Neurol N 2008; 71/104(6): 711-716
Category: Short Communication

Overview

Introduction:
Anterior access has dominated surgical treatment of cervical radiculopathy since the 1960’s. Posterior cervical foraminotomy is indicated at some centres for the treatment of lateral and intraforaminal herniations in the region of cervical spine, but simultaneous medioventral ablation of osteophytes medio-ventrally from the root may be problematic if the above access is used. The authors report their first experience in the treatment of radiculopathy using anterior cervical microforaminotomy.

Material and methods:
15 patients of which 5 women and 10 men aged from 31 to 65 years were enrolled in the study based on their informed consent. Clinical difficulties in all of them correlated with a unilateral monosegmental finding in the foramen detected by graphic examinations. Surgeries were performed using the standard anterior access, always on the side where the pathology was located. The indicated segment was prepared asymmetrically with an overlap over m. longus colli of the clinical side. The uncinate process was drilled and the root was decompressed in the trajectory of foramen. The results were evaluated three and six months, and one and two years post‑operation. Dynamic images of cervical spine were made one and two years post‑op.

Results:
Radicular irritation disappeared completely in 11 patients while four patients reported its persistence, however, without any deterioration as compared with the situation before the surgery. No new root lesion or injury to the cervical sympathetic chain were detected. No injury to the vertebral artery was reported either. Control dynamic images of the cervical spine did not show any newly developed instability.

Conclusion:
Anterior cervical microforaminotomy is a safe surgical technique for the decompression of the nerve root compressed in the foramen and for the removal of the material pressing on the root medioventrally. This technique does not involve the risk of segmental instability if indicated in patients with more severe spondylarthritic changes in the segment to be treated.

Key words:
cervical spine – anterior access – lateral microforaminotomy

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