Minimally invasive anterior foraminotomy for cervical radiculopathy: how I do it

Maduri, Rodolfo; Bobinski, Lukas; Duff, John Michael

doi:10.1007/s00701-019-04201-y

Cited by 8 publications

(7 citation statements)

References 7 publications

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“…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 ).…”

Section: Introductionmentioning

confidence: 99%

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

Zhang

et al. 2021

Front. Bioeng. Biotechnol.

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Minimally invasive surgeries, including posterior endoscopic cervical foraminotomy (PECF), microsurgical anterior cervical foraminotomy (MACF), anterior transdiscal approach of endoscopic cervical discectomy (ATd-ECD), and anterior transcorporeal approach of endoscopic cervical discectomy (ATc-ECD), have obtained positive results for cervical spondylotic radiculopathy. Nonetheless, there is a lack of comparison among them regarding their biomechanical performance. The purpose of this study is to investigate the biomechanical changes of operated and adjacent segments after minimally invasive surgeries compared to a normal cervical spine. A three-dimensional model of normal cervical vertebrae C3–C7 was established using finite element analysis. Afterwards, four surgical models (PECF, MACF, ATd-ECD, and ATc-ECD) were constructed on the basis of the normal model. Identical load conditions were applied to simulate flexion, extension, lateral bending, and axial rotation of the cervical spine. We calculated the range of motion (ROM), intradiscal pressure (IDP), annulus fibrosus pressure (AFP), uncovertebral joints contact pressure (CPRESS), and facet joints CPRESS under different motions. For all circumstances, ATc-ECD was close to the normal cervical spine model, whereas ATd-ECD significantly increased ROM and joints CPRESS and decreased IDP in the operated segment. PECF increased more the operated segment ROM than did the MACF, but the MACF obtained maximum IDP and AFP. Except for ATc-ECD, the other models increased joints CPRESS of the operated segment. For adjacent segments, ROM, IDP, and joints CPRESS showed a downward trend in all models. All models showed good biomechanical stability. With their combination biomechanics, safety, and conditions of application, PECF and ATc-ECD could be appropriate choices for cervical spondylotic radiculopathy.

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Section: Introductionmentioning

confidence: 99%

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

Zhang

et al. 2021

Front. Bioeng. Biotechnol.

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“…The use of tubular systems has been described and is a valid alternative. 4 3:15 Preoperative Imaging. Important anatomical structures for the procedure are highlighted here.…”

Section: Transcriptmentioning

confidence: 99%

Minimally invasive anterior cervical foraminotomy for unilateral radiculopathy

Trimble,

Sheinberg,

Cochran

2024

Neurosurgical Focus: Video

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Anterior cervical foraminotomy (ACF) is an alternative surgical option for the treatment of refractory unilateral radiculopathy due to disc herniation or spondylosis. The efficacy and adverse event rate in experienced practitioners are comparable to those of anterior cervical discectomy and fusion, total disc arthroplasty, and posterior foraminotomy. However, this technique has not been widely adopted, likely because of the proximity of the working zone and the vertebral artery. The authors present a detailed operative video of a patient successfully treated with an ACF. They also present a review of the ACF literature. The video can be found here: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23196

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“…The surgical technique used in this cohort of patients is similar to that described by Jho [4] and Saringer et al [12] with the additional usage of tubular retractor [17]. The key steps of our surgical technique were summarized as follows: Through a 2 cm skin incision centered over the anterior border of the sternocleidomastoid muscle, the skin flaps were undermined and the platysma was opened along the lines of its fibers.…”

Section: Surgical Techniquementioning

confidence: 99%

“…We have recently described a variant of the "minimally invasive" technique for ACF using tubular retractors for transuncal decompression of compressive cervical radiculopathy [17]. The use of tubular retractors not only facilitates soft tissue retraction but also helps to ensure the appropriate surgical trajectory for bone resection leading directly to the neural foramen.…”

Section: Introductionmentioning

confidence: 99%

Transtubular Anterior Cervical Foraminotomy for the Treatment of Compressive Cervical Radiculopathy: Surgical Results and Complications in a Consecutive Series of Cases

et al. 2021

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Study Design: This was a retrospective review of patients with compressive cervical radiculopathy treated with a minimally invasive anterior cervical foraminotomy (ACF).Purpose: This study aimed to evaluate the results and complication rates of ACF in a consecutive series of patients and to report our clinical results of ACF as a minimally invasive technique in a series of 45 consecutive patients treated for compressive cervical radiculopathy.Overview of Literature: ACF is a motion-sparing procedure and an alternative to anterior cervical discectomy and fusion (ACDF) and posterior cervical foraminotomy for direct nerve root decompression in patients with compressive cervical radiculopathy.Methods: The chart review recorded clinical and radiological features preoperatively and postoperatively and at follow-up (FU). The effect of prognostic factors was analyzed in relation to the clinical outcome.Results: Between January 2004 and October 2019, 45 patients (15 females and 30 males) with a mean age of 55.9 years (range, 28–78 years) underwent ACF for unilateral cervical radiculopathy. The global clinical outcome according to the MacNab scale was evaluated as excellent in 64.5% of patients (n=29), good in 28.9% (n=13), fair in 4.4% (n=2), and poor in 2.2% (n=1). The radiological FU was available for 73.3% (n=33). The statistical analysis revealed no influence of age, sex, operated level, and side on the clinical outcome. Only one patient (2.2%) exhibited spontaneous bone fusion at the operated level on FU after a right-sided C6–7 ACF with no clinical consequences. No patient presented with signs of delayed segmental instability. The overall reoperation rate of this series was 4.4%.Conclusions: ACF is a feasible and low-cost alternative to ACDF in selected patients with cervical radiculopathy. The use of tubular retractors in ACF may confer an added advantage that creates a safe corridor for direct cervical root decompression yet minimizing surrounding soft tissue retraction and avoiding unnecessary bone removal.

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Minimally invasive anterior foraminotomy for cervical radiculopathy: how I do it

Cited by 8 publications

References 7 publications

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

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

Minimally invasive anterior cervical foraminotomy for unilateral radiculopathy

Transtubular Anterior Cervical Foraminotomy for the Treatment of Compressive Cervical Radiculopathy: Surgical Results and Complications in a Consecutive Series of Cases

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