J Korean Orthop Assoc.  2014 Oct;49(5):394-399. 10.4055/jkoa.2014.49.5.394.

Total Uncinatectomy Revisited: Revision Surgery for Persistent Radiculopathy Following Anterior Cervical Discectomy and Fusion (ACDF)

• Hong WK
• Kang SS
• Lee DB
• Kim HJ
• Yi J
• Cho HG
• Chang BS
• Lee CK
• Yeom JS

• KMID: 2185177
• DOI: http://doi.org/10.4055/jkoa.2014.49.5.394

Abstract

We report on a case involving total en bloc uncinatectomy of C7 without removal of the previously inserted cage, performed on a patient with a history of previous anterior cervical discectomy and fusion without uncoforaminotomy at C5-6-7 who had persistent pain radiating to the upper extremity along with progressive weakness. Satisfactory results were achieved. This procedure should be regarded as an effective option for surgical treatment of persistent or recurrent radiculopathy caused by remaining foraminal stenosis following anterior cervical fusion, and we suggest it as a new indication for this procedure.

Keyword

uncinate process; uncovertebral joint; radiculopathy; total uncinatectomy; anterior cervical discectomy and fusion

MeSH Terms

Constriction, Pathologic
Diskectomy*
Humans
Radiculopathy*
Upper Extremity

Figure

• 

  Figure 1 Lateral radiographs taken in flexion (A) and extension (B) at 14 months after the initial operation are shown. The difference in interspinous distances at C5-6 was 2.5 mm, suggesting nonunion at this level.

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  Figure 2 Computed tomography scan images are shown. (A) A left foraminal oblique image shows nonunion at C5-6 (black arrowhead) and large foraminal spurs at C6-7 (white arrowhead). (B) An axial image shows a large foraminal spur from the left uncinate process of C7 (black arrowhead).

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  Figure 3 T2-weighted magnetic resonance images show a large foraminal spur (white arrowhead) from the left uncinate process of C7 (A), spinal cord compression between the herniated disc and slightly buckled ligamentum flavum at C4-5 (B, C), and cord signal change at C5-6 (C).

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  Figure 4 Left foraminal oblique (A), axial (B), and 3-dimensional computed tomography (C) scan images taken 2 days after the revision surgery show complete resection of the left C7 uncinate spur (arrowheads) and satisfactory decompression.

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  Figure 5 Lateral radiographs taken in flexion (A) and extension (B) at 12 months after the revision surgery show solid fusion of the 3 surgical levels with difference in interspinous distances of less than 1 mm at each level.

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