Transvertebral anterior cervical foraminotomy: midterm outcomes of clinical and radiological assessments including the finite element method

Abstract

Purpose The aim of this study was to compare the clinical features, radiological changes, biomechanical effects, and efficacy in patients treated by transvertebral anterior foraminotomy. Preservation of segmental motion and avoidance of adjacent segment degeneration are theoretical advantages of transvertebral anterior foraminotomy. In practice, this procedure is minimally invasive and has shown good clinical results, especially in patients with unilateral cervical radiculopathy. Method We conducted a retrospective minimum 2-year follow-up study of the cervical spine of patients treated by transvertebral anterior foraminotomy at our institution. Radiological outcomes, which were estimated by measuring disc and functional spinal unit heights, and the angle and range of motion (ROM) from C2 to C7 of the functional spinal unit and adjacent segments were evaluated. Furthermore, a three-dimensional finite element method was used to biomechanically analyze the strength of the postoperative vertebral body. Results Between 2004 and 2009, 34 patients underwent surgery. The improvement rate was 94.2 %. The average flexion-extension ROM from C2 to C7 was 36.6 ± 16.6°. On plain radiographs, the disc height and ROM and height of the functional spinal unit in the operated segment were not significantly decreased relative to the preoperative levels. The finite element method also revealed that there was no difference in strength between the pre-and postvertebral bodies.Conclusions These results demonstrate that biomechanical stability was achieved. Transvertebral anterior cervical foraminotomy did not limit motion in the operated and adjacent segments and did not cause a significant decrease in disc and vertebral heights after surgery.

Ultrasonic Total Uncinectomy

“…[11][12][13][14][15][16][17][18][19][20] In all of these reports, the goal has been to preserve the disk space and to avoid a fusion, which by necessity limits visualization and access to the uncinate process. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Despite the aforementioned modifications, the technique for standalone anterior cervical foraminotomy remains challenging and carries a significant risk of complications in inexperienced hands. 22 Anatomical morphometric analysis has revealed the distance between the vertebral artery and the lateral margin of the uncinate process to be 1.7 to 2.8 mm, leaving little margin for error.…”

Microsurgery or open cervical foraminotomy for cervical radiculopathy? A systematic review

“…Three publications were excluded because they did not reported the clinical success rate in the microsurgery group [20][21][22] compared with six publications in the open group [23][24][25][26][27], and one was excluded because it reported patients younger than 15 years (n = 13) in the open group [28]. …”

Cervical cages placed bilaterally in the facet joints from a posterior approach significantly increase foraminal area

“…Direct decompression can be achieved via anterior cervical discectomy and fusion, transvertebral anterior cervical foraminotomy or posterior foraminotomy [1,4,5]. The anterior approach provides both direct and indirect decompression with direct resection of degenerative tissue and disc height restoration [1,4].…”