Technical Evolution of Anterior Microforaminotomy for Unilateral Cervical Radiculopathy

Kim, Dae Yong; Kim, Woo Kyung; Lee, Sang Gu; Kim, Young Bo; Park, Cheol Wan; Park, Chan Woo

Abstract

OBJECTIVE
Cervical disc disease causing radiculopathy has been treated using either an anterior or a posterior approach. This paper includes the technical evolution of anterior microforaminotomy which is one of the minimally invasive approaches for cervical radiculopathy. METHODS: Anterior cervical microforaminotomy was underwent 40 patients from June 2000 to June 2002. Inclusion criteria were ; 1) Patients should have the unilateral cervical radiculopathy not responding to conservative treatments for more than 2-3 month ; 2) Various radiologic diagnosis should reveal their clinical symptoms ; 3) Patients should not have the previous surgical treatments for their cervical spine. Anterior microforaminotomy was performed via either old transuncal approach or new upper vertebral transcorporeal approach. RESULTS: Original transuncal approach was performed for 28 patients and 12 patients were operated via a newly developed upper vertebral transcorporeal approach for their cervical radiculopathy. In transuncal approach, the entry point was the uncovertebral juncture. But, when a foraminotomy hole is made posteriorly, it usually leads to the caudal edge of the neural foramen rather than the actual nerve root foramen. To approach the neural foramen precisely the foraminotomy hole was made rostral to the uncinate tip in upper vertebral transcorporeal approach. The patients also did not experience nuchal pain and would avoid brace, and were back to work more quickly. CONCLUSION: Anterior microforaminotomy is developed in order to preserve the remaining disc in the intervertebral disc as much as possible while eliminating the compressive pathology directly. It is found that upper vertebral transcorporeal approach minimizes damage to the remaining intervertebral disc and leads to the pathology more precisely.