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Minim Invasive Neurosurg 2006; 49(6): 323-327
DOI: 10.1055/s-2006-956507
Original Article

© Georg Thieme Verlag KG · Stuttgart · New York

Anterior Uncoforaminotomy in the Treatment of Recurrent Radiculopathy after Anterior Cervical Discectomy with Fusion

I. Pechlivanis 1 , C. Brenke 1 , M. Scholz 1 , M. Engelhardt 1 , A. Harders 1 , K. Schmieder 1
  • 1Department of Neurosurgery, Ruhr-University of Bochum, Knappschaftskrankenhaus, Bochum-Langendreer, Germany
Further Information

Publication History

Publication Date:
23 February 2007 (online)

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Abstract

Background: In patients after anterior cervical discectomy (ACD) with fusion newly developed retrospondylophytes or incomplete decompression of the nerve root can cause recurrent radicular pain. Anterior cervical uncoforaminotomy (uncoforaminotomy) is an operative method which removes the causative degenerative pathology at the level of the neural foramen leaving untouched the inserted graft at this level. Method: Between February 2004 and April 2005, 7 patients underwent uncoforaminotomy after ACD with fusion for the treatment of recurrent cervical radiculopathy in our neurosurgical department. Prior to treatment patients received a computed tomography (CT) and a neurological examination. Anterior uncoforaminotomy was performed thereafter (for technical details see publication by Jho, 1996). A postoperative CT scan was done before discharge. Follow-up examination was performed eight weeks after surgery. Findings: Five patients underwent the operation at C5/6, one patient was operated at C6/7 and one patient had the operation at two levels (C5/6 and C6/7). At discharge six patients had excellent or good results. Conclusion: Uncoforaminotomy is a good method for the treatment of newly acquired spondylotic spurs in the foramen or incomplete osseous decompression after ACD with fusion and recurrent radicular pain.

Key words

Radicular pain - anterior uncoforaminotomy - ACD - spine

References

  • 1 Martins AN. Anterior cervical discectomy with and without interbody bone graft.  J Neurosurg. 1976;  44 290-295
    PubMedGoogle Scholar
  • 2 Ehni B, Ehni G, Patterson RHJ. Epidural spinal cord and nerve root compression from benign lesions of the cervical area. In: Youmans JR (ed). Neurological Surgery, 3rd edn,. WB Saunders Co., Philadelphia 1990: 2905-2906
    Google Scholar
  • 3 Harris NM, Smith AJ. Rationale and technique for anterior fusion.  Clin Orthop. 1962;  24 94-112
    PubMedGoogle Scholar
  • 4 Hankinson HL, Wilson CB. Use of the operating microscope in anterior cervical discectomy without fusion.  J Neurosurg. 1975;  43 452-456
    PubMedGoogle Scholar
  • 5 Henderson CM. et al . Posterior lateral foraminotomy as an exclusive operative technique for cervical radicuopathy: a review of 846 consecutive operated cases.  Neurosurgery. 1983;  13 504-512
    PubMedGoogle Scholar
  • 6 Lundsford LD. et al . Anterior surgery for cervical disc disease. Part I: Treatment of lateral disc herniation in 253 cases.  J Neurosurg. 1980;  53 1-11
    CrossrefPubMedGoogle Scholar
  • 7 Rosomoff HL, Rossmann F. Treatment of cervical spondylosis by anterior cervical diskectomy and fusion.  Arch Neurol. 1966;  14 392-398
    PubMedGoogle Scholar
  • 8 Smith GW, Robinson RA. The treatment of certain cervical spinal disorders by anterior removal of the intervertebral disc and interbody fusion.  J Bone Joint Surg [Am]. 1958;  40 607-624
    CrossrefPubMedGoogle Scholar
  • 9 Hakuba A. Trans-unco-discal approach. A combined anterior and lateral approach to cervical discs.  J Neurosurg. 1976;  45 284-291
    PubMedGoogle Scholar
  • 10 Jho HD. Microsurgical anterior cervical foraminotomy for radiculopathy: a new approach to cervical disc herniation.  J Neurosurg. 1996;  84 155-160
    CrossrefPubMedGoogle Scholar
  • 11 Verbiest H. A lateral approach to the cervical spine: technique and indications.  J Neurosurg. 1968;  28 191-203
    CrossrefPubMedGoogle Scholar
  • 12 Jho HD. Editorial, Failed anterior cervical foraminotomy.  J Neurosurg Spine. 2003;  98 121-125
    CrossrefPubMedGoogle Scholar
  • 13 Saringer W. et al . Microsurgical anterior cervical foraminotomy (uncoforaminotomy) for unilateral radiculopathy: clinical results of a new technique.  Acta Neurochir (Wien). 2002;  144 685-694
    CrossrefPubMedGoogle Scholar
  • 14 Baba H. et al . Late radiographic findings after anterior cervical fusion for spondylotic myeloradiculopathy.  Spine. 1993;  18 2167-2173
    CrossrefPubMedGoogle Scholar
  • 15 Bertalanffy H, Eggert HR. Clinical long-term results of anterior discectomy without fusion for treatment of cervical radiculopathy and myelopathy. A follow-up of 164 cases.  Acta Neurochir (Wien). 1988;  90 127-135
    CrossrefPubMedGoogle Scholar
  • 16 Gore DR. et al . Roentgenographic findings following anterior cervical fusion.  Skeletal Radiol. 1986;  15 556-559
    CrossrefPubMedGoogle Scholar
  • 17 Hunter LY, Braunstein EM, Bailey RW. Radiographic changes following anterior cervical fusion.  Spine. 1980;  5 399-401
    CrossrefPubMedGoogle Scholar
  • 18 Hilibrand AS. et al . The success of anterior cervical arthrodesis adjacent to a previous fusion.  Spine. 1997;  22 1574-1579
    CrossrefPubMedGoogle Scholar
  • 19 Adamson TE. Microendoscopic posterior cervical laminoforaminotomy for unilateral radiculopathy: results of a new technique in 100 cases.  J Neurosurg Spine. 2001;  95 51-57
    CrossrefPubMedGoogle Scholar
  • 20 Clements DH, O'Leary PF. Anterior cervical discectomy and fusion.  Spine. 1990;  15 1023-1025
    CrossrefPubMedGoogle Scholar
  • 21 DePalma AF. et al . Anterior interbody fusion for severe cervical disc degeneration.  Surg Gynecol Obstet. 1972;  134 755-758
    PubMedGoogle Scholar
  • 22 Lundsford LD. et al . Anterior surgery for cervical disc disease. Part 1: Treatment of lateral cervical disc-herniation in 253 cases.  J Neurosurg. 1973;  53 679-683
    PubMedGoogle Scholar
  • 23 Matge G. Anterior interbody fusion with the BAK-cage in cervical spondylosis.  Acta Neurochir (Wien). 1998;  140 1-8
    CrossrefPubMedGoogle Scholar
  • 24 Murphy MG, Gado M. Anterior cervical discectomy without interbody bone graft.  J Neurosurg. 1972;  37 71-74
    PubMedGoogle Scholar
  • 25 Savolainen S, Rinne J, Hernesniemi J. A prospective randomized study of anterior single-level cervical disc operations with long-term follow-up: surgical fusion is unnecessary.  Neurosurgery. 1998;  43 51-55
    PubMedGoogle Scholar
  • 26 Watters 3rd WC, Levinthal R. Anterior cervical discectomy with and without fusion. Results, complications, and long-term follow-up.  Spine. 1994;  19 2343-2347
    CrossrefPubMedGoogle Scholar
  • 27 Brooke NSR. et al . Preliminary experience of carbon fiber cage prostheses for treatment of cervical spine disorders.  Br J Neurosurg. 1997;  11 221-227
    CrossrefPubMedGoogle Scholar
  • 28 Schmieder K. et al .Anterior cervical interbody fusion with Wing titanium cages. In: Kaech DL, Jinkins JR, editors. Spinal restabilization procedures. New York, Elsevier 2002: 229-234
    Google Scholar
  • 29 Coric D, Branch CL, Jenkins JD. Revision of anterior cervical pseudarthrosis with anterior allograft fusion and plating.  J Neurosurg. 1997;  86 969-974
    CrossrefPubMedGoogle Scholar
  • 30 Brodsky AE. et al . Repair of symptomatic pseudarthrosis of anterior cervical fusion. Posterior versus anterior repair.  Spine. 1992;  17 1137-1143
    PubMedGoogle Scholar
  • 31 Farey ID. et al . Pseudarthrosis of the cervical spine after anterior arthrodesis. Treatment by posterior nerve-root decompression, stabilization, and arthrodesis.  J Bone Joint Surg [Am]. 1990;  72 1171-1177
    PubMedGoogle Scholar
  • 32 Fuji T. et al . Interspinous wiring without bone grafting for nonunion or delayed union following anterior spinal fusion of the cervical spine.  Spine. 1986;  9 667-671
    PubMedGoogle Scholar
  • 33 Lindesey RW. et al . Nonunion following two-level anterior cervical discectomy and fusion.  Clin Orthop. 1987;  223 155-163
    PubMedGoogle Scholar
  • 34 Elsig JP, Sgier F, Warden KE. Anterior cervical interbody fusion using PEKEKK composite cages. In: Kaech DL, Jinkins JR, editors. Spinal Restabilization Procedures. New York, Elsevier 2002: 213-222
    Google Scholar
  • 35 Lowery GL, Swank ML, McDonough MF. Surgical revision for failed anterior cervical fusions.  Spine. 1995;  20 2436-2441
    CrossrefPubMedGoogle Scholar

Correspondence

Dr. med. Ioannis Pechlivanis

Department of Neurosurgery·Ruhr-University of Bochum

Knappschaftskrankenhaus

In der Schornau 23-25

44892 Bochum

Germany

Phone: +49/234/299 36 01

Fax: +49/234/299 36 09

Email: ioannis.pechlivanis@ruhr-uni-bochum.de