Anterior cervical foramenotomy for cervical radiculopathy

Abstract

Anterior cervical discectomy (ACD) is standard practice for cervical radiculopathy. Irrespective of the precise method used, it involves more or less complete disc removal with resultant anatomical and biomechanical derangements, and frequently the insertion of a bone or prosthetic graft. Anterior cervical foramenotomy is an alternative procedure that allows effective anterior decompression of the nerve root and lateral spinal cord, whilst conserving the native disc, preserving normal anatomy and movement, and protecting against later degeneration at adjacent spaces as far as possible. The aim of the study was to determine the safety and efficacy of anterior cervical foramenotomy in the treatment of cervical radiculopathy and took the form of a prospective study of 21 cases under the care of a single surgeon. All patients had a single level or two level anterior cervical foramenotomy. All had pre- and postoperative visual analogue scores for arm and neck pain, arm strength, sensation and overall use. A comparison between patients' perceptions and surgeon's observations was also made. Patients were followed up for between 10 and 36 months. Sixty-eight per cent completed full pre- and postoperative assessments. Twenty-eight per cent of the responders had complete arm pain resolution. There were statistically significant reductions in arm and neck pain, and overall disability. The surgeon's impression of improvement paralleled that of the patients. There was one complication with discitis. Anterior cervical foramenotomy is a safe and effective treatment for cervical radiculopathy caused by posterolateral cervical disc prolapse or uncovertebral osteophyte, and might also reduce adjacent segment degeneration.

Extent of Disc Degeneration after Single-Level Cervical Anterior Microforaminotomy Analyzed with Long-Term Radiological Data

“…With the classic transuncal AMF procedure, most authors have reported favorable outcomes in 91-99% of patients1,5,7,8,11). Various modified AMF procedures have shown favorable outcomes in 91-100% of patients2,3,9,13,17,21). In the present series, improvement was found in 91.7% of patients.…”

“…In 1996, Jho7) described a transuncal approach to AMF, performed through the uncinate process (UP) to preserve the remaining disc. Since then, many authors have reported favorable clinical outcomes of AMF or similar procedures1,2,3,5,8,9,11,13,17,21). and only several authors have described about radiologic outcomes of AMF, including the appearance of instability, static deformity, and a decrease in disc height, although the follow-up period have been relatively short1,5).…”

Indications for anterior cervical decompression for the treatment of cervical degenerative radiculopathy

“…Johnson et al, 11 Koc et al, 13 and White et al 25 each described smaller, Class III series using a similar ACF technique. Johnson and colleagues 11 reported on 21 patients with cervical radiculopathy who underwent ACF.…”

“…13 White et al 25 reported on 21 patients with cervical radiculopathy who underwent 1-or 2-level ACF, in 14 and 7 patients, respectively. The authors assessed outcomes by patients and surgeons using the VAS over 10-36 months.…”

Cervical Radiculopathy due to Cervical Degenerative Diseases : Anatomy, Diagnosis and Treatment

“…The long-term disadvantages, however, include disc degeneration and unilateral removal of an uncoverbral joint 15,25) . Surgical outcomes are generally good 15,23,25,58) , but Hacker et al 15) reported the poor results could arise from poor patient selection, poor surgical technique, or an inherent problem with the produre. Reports emphasize patient selection as the single most important determinant of outcome; patients with unilateral (one-or two-level) symptoms and minimal neck pain show favorable outcomes for this surgery.…”