Total uncinectomy of the cervical spine with an osteotome: technical note and intraoperative video

Segar, Anand; Riccio, Alexander R.; Smith, Michael L.; Protopsaltis, Themistocles S.

doi:10.3171/2019.6.spine19332

Cited by 8 publications

(5 citation statements)

References 12 publications

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“…It was in agreement with multiple studies that the indication of ACDF with UPR was CR with foraminal stenosis caused by osteophytes of hypertrophied UP. 17,18,27,28,32,33 In accordance with Sun B’s study, the width of the intervertebral foramen (wIVF) was found to be significantly associated with the improvement in post-operative outcomes. 17 The author reported that patients with pre-operative wIVF<3mm who underwent ACDF with UPR had significantly better improvement of post-operative clinical symptoms than those who underwent ACDF alone, which quantified the severity of foraminal stenosis in the indication.…”

Section: Discussionsupporting

confidence: 76%

Safety and Efficacy of Anterior Cervical Discectomy and Fusion with Uncinate Process Resection: A Systematic Review and Meta-Analysis

Yin

Ding

Zhu

et al. 2022

Global Spine Journal

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Study design This is a meta-analysis and systematic review of the available literature. Objective In the case of severe foraminal stenosis, conducting uncinate process resection (UPR) during ACDF could achieve complete nerve root decompression and significant relief of neurological symptoms for CR. However, there is some controversy regarding its necessity and safety. This study aims to compare the safety and efficacy of ACDF with UPR and ACDF. Methods The following electronic databases were searched: Medline, PubMed, Embase, the Cochrane Central Register of Controlled Trials, Evidence Based Medicine Reviews, VIP, and CNKI. And the following data items were considered: baseline demographics, efficacy evaluation indicators, radiographic outcome, and surgical details. Results 10 studies were finally identified, including 746 patients who underwent ACDF with UPR compared to 729 patients who underwent ACDF. The group of ACDF with UPR had statistically longer intraoperative time (95% CI: 4.83, 19.77, P = .001) and more intraoperative blood loss (95% CI: 12.23, 17.76, P < .001). ACDF with UPR obtained a significantly better improvement of Arm VAS at postoperative first follow-up (95% CI: −1.85, −.14 P = .02). There was no significant difference found in improvement of Neck VAS at postoperative latest follow-up (95% CI: −.88, .27, P = .30), improvement of Arm VAS at postoperative latest follow-up (95% CI: −.59, −.01, P = .05), improvement of NDI (95% CI: −2.34, .33, P = .14), JOA (95% CI: −.24, .43, P = .56), change of C2-C7 lordosis (95% CI: −.87, 1.33, P = .68), C2-C7 SVA (95% CI: −.73, 5.08, P = .14), T1 slope (95% CI: −2.25, 1.51, P = .70), and fusion rate (95% CI: .83, 1.90 P = .29). Conclusion ACDF with UPR is an effective and necessary surgical method for CR patients with severe foraminal stenosis.

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Section: Discussionsupporting

confidence: 76%

Safety and Efficacy of Anterior Cervical Discectomy and Fusion with Uncinate Process Resection: A Systematic Review and Meta-Analysis

Yin

Ding

Zhu

et al. 2022

Global Spine Journal

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“…[ 17 ] In deformity correction, the risk of arterial injury during the surgical treatment by the anterior, posterior, or combined approaches is increased. [ 18 19 20 21 ] This is compounded by the challenges posed by the tortuous course the vertebral artery may take due to abnormalities or variants to the normal anatomy associated with diseases and disorders of the craniovertebral junction. [ 22 ] Therefore, a preoperative angiogram is essential to have a meticulous understanding of the vascular anatomy of each patient.…”

Section: Discussionmentioning

confidence: 99%

Unilateral spacer distraction of the subaxial cervical facet joint for the treatment of fixed coronal malalignment of the craniovertebral junction

Carelli

Girão

Cechin

et al. 2022

Journal of Craniovertebral Junction and Spine

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Introduction: The standard treatment for a fixed coronal malalignment of the craniovertebral junction is an anterior and/or posterior column osteotomy (PCO) plus instrumentation. However, the procedure is very challenging, carrying an inherently high risk of complications even in experienced hands. This case series demonstrates the usefulness of an alternative treatment that adds a unilateral spacer distraction (USD) to the subaxial cervical facet joint to promote coronal realignment and fusion. Materials and Methods: A single-center retrospective study of the patients with fixed coronal malalignment of the craniovertebral junction caused by different etiologies treated with USD in the concavity side with PCO in the convexity side of the subaxial cervical spine. Demographic characteristics and radiological parameters were collected with special emphasis on clinical and radiological measurements of coronal alignment of the cervical spine. Results: From 2012 to 2019, four patients were treated with USD of the subaxial cervical spine complementing an asymmetrical PCO at the same level. The causes of coronal imbalance were congenital, tuberculosis, posttraumatic, and ankylosing spondylitis. The level of USD was C2–C3 in three patients and C3–C4 in one patient. A substantial coronal realignment was achieved in all four. One patient had an iatrogenic vertebral artery injury during the dissection and facet distraction and developed Wallenberg's syndrome with partial recovery. Conclusions: USD of the concave side with unilateral PCO of the convexity side in the subaxial cervical spine is a promising alternative treatment for fixed coronal malalignment of the craniovertebral junction from different causes.

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“…Uncinatectomy has historically been a controversial procedure, with many advocating for avoidance due to the risk of vertebral artery and nerve root injury [7,8]. There have been several proposed techniques for safe uncinate removal, including extensive lateral exposure of the vertebral artery, use of an osteotome, and use of an ultrasonic aspirator [9,10]. In our experience, we have found that the passage of a freer dissector lateral to the uncinate border provides adequate protection of the neurovascular structures of the cervical foramen.…”

Section: Discussionmentioning

confidence: 99%

Total Anterior Uncinatectomy During Anterior Discectomy and Fusion for Recurrent Cervical Radiculopathy: A Two-dimensional Operative Video and Technical Report

Valero-Moreno

Clifton

Damon

et al. 2020

Cureus

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A common cause of cervical radiculopathy from degenerative foraminal stenosis is severe uncovertebral hypertrophy. It is difficult to accomplish complete foraminal decompression in these cases with posterior techniques without the removal of a large portion of the facet joint. Total removal of the uncovertebral joint from an anterior approach allows for complete decompression of the exiting cervical nerve root and has been shown to be a safe technique. In this surgical video and technical report, we demonstrate the surgical anatomy and operative technique of a two-level anterior uncinatectomy during anterior discectomy and fusion (ACDF) for recurrent cervical radiculopathy after a previous multi-level posterior foraminotomy. The patient is a 67-year-old male with a progressive left arm and neck pain with radiographic, clinical, and electrophysiologic diagnostic evidence of active C6 and C7 radiculopathies from degenerative foraminal stenosis at the C5-6 and C6-7 levels. Posterior foraminotomies had been performed without significant improvement in his radicular pain. A repeat MRI demonstrated lateral foraminal stenosis from severe uncovertebral joint hypertrophy at the C5-6 and C6-7 levels. After acquiring informed consent from the patient, an anterior approach was performed with complete removal of the uncovertebral joints at both levels with discectomy and fusion. Postoperatively, the patient had complete resolution of his radicular pain and remained pain-free at the latest follow-up. Complete uncinatectomy and ACDF is an effective technique for complete foraminal decompression in cases of refractory radiculopathy and neck pain after unsuccessful posterior decompression.

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Total uncinectomy of the cervical spine with an osteotome: technical note and intraoperative video

Cited by 8 publications

References 12 publications

Safety and Efficacy of Anterior Cervical Discectomy and Fusion with Uncinate Process Resection: A Systematic Review and Meta-Analysis

Safety and Efficacy of Anterior Cervical Discectomy and Fusion with Uncinate Process Resection: A Systematic Review and Meta-Analysis

Unilateral spacer distraction of the subaxial cervical facet joint for the treatment of fixed coronal malalignment of the craniovertebral junction

Total Anterior Uncinatectomy During Anterior Discectomy and Fusion for Recurrent Cervical Radiculopathy: A Two-dimensional Operative Video and Technical Report

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