Microanatomical considerations for safe uncinate removal during anterior cervical discectomy and fusion: 10‐year experience

Abstract

Cervical radiculopathy from uncovertebral joint (UVJ) hypertrophy and nerve root compression often occurs anterior and lateral within the cervical intervertebral foramen, presenting a challenge for complete decompression through anterior cervical approaches owing to the intimate association with the vertebral artery and associated venous plexus. Complete uncinatectomy during anterior cervical discectomy and fusion (ACDF) is a controversial topic, many surgeons relying on indirect nerve root decompression from restoration of disc space height. However, in cases of severe UVJ hypertrophy, indirect decompression does not adequately address the underlying pathophysiology of anterolateral foraminal stenosis. Previous reports in the literature have described techniques involving extensive dissection of the cervical transverse process and lateral uncinate process (UP) in order to identify the vertebral artery for safe removal of the UP. Recent anatomical investigations have detailed the microanatomical organization of the fibroligamentous complex surrounding the UP and neurovascular structures. The use of the natural planes formed from the encapsulation of these connective tissue layers provides a safe passage for lateral UP dissection during anterior cervical approaches. This can be performed from within the disc space during ACDF to avoid extensive lateral dissection. In this article, we present our 10‐year experience using an anatomy‐based microsurgical technique for safe and complete removal of the UP during ACDF for cervical radiculopathy caused by UVJ hypertrophy.

Comparative Analysis of the Biomechanical Characteristics After Different Minimally Invasive Surgeries for Cervical Spondylopathy: A Finite Element Analysis

“…Aside from a herniated disc, secondary osseous foraminal stenosis resulting from UJ osteophytes can also potentially induce cervical spondylotic radiculopathy ( Boreadis and Gershon-Cohen, 1956 ; Snyder et al, 2007 ; Brismée et al, 2009 ; Clifton et al, 2020 ). Previous research demonstrated that the direct decompression of foraminal stenosis by resecting UJ effectively relieved the symptoms of nerve compression ( Jho, 1997 ; Saringer et al, 2002 ; Saringer et al, 2003 ; Kotil and Bilge, 2008 ).…”

“…MACF is regarded as an alternative functional surgery and can preserve segmental motion compared with anterior cervical discectomy and fusion ( Maduri et al, 2020 ). And it can also represent a supplement surgery to better improve arm pain after conducting anterior cervical discectomy and fusion ( Lee et al, 2018 ; Clifton et al, 2020 ; Noh et al, 2020 ). A key step of MACF is the necessary removal of hypertrophied UJs to expand the intervertebral foramen and decompress the nerve root ( Taşçioğlu et al, 2001 ; Clifton et al, 2019 ).…”

Posterior cervical full-endoscopic technique for the treatment of cervical spondylotic radiculopathy with foraminal bony stenosis: A retrospective study

“…However, the removal of the Luschka joint may lead to the prosthesis subsidence and the cervical instability. Therefore, whether the Luschka joint should be resected is still controversial in the clinical practice ( 15 , 16 ). PCF can not only remove the herniated intervertebral disc, but also grind off the posterior osteophyte and loosen the adhesion around the nerve root under the premise of preserving the Luschka joint.…”

Posterior Cervical Full-endoscopic Technique for the Treatment of Cervical Spondylotic Radiculopathy with Foraminal Bony Stenosis: A Retrospective Study

“…However, the removal of the Luschka joint may lead to the prosthesis subsidence and the cervical instability. Therefore, whether the Luschka joint should be resected is still controversial in the clinical practice [14,15]. PCF can not only remove the herniated intervertebral disc, but also grind off the posterior osteophyte and loosen the adhesion around the nerve root under the premise of preserving the Luschka joint.…”