Cervical nerve root decompression by lateral approach as salvage operation after failed anterior transdiscal surgery: technical case report

Abstract OBJECTIVE We previously reported our technique of selective microforaminotomy via an anterolateral approach for the treatment of spondylotic radiculopathy. We now report the clinical long-term results. METHODS A retrospective study of 40 patients who consecutively underwent operation via this technique was performed. Patients' demographic, clinical presentation, and radiological and surgical data were recorded by chart review. Long-term clinical outcome was assessed by a questionnaire, office visits, and intensive telephone interviews. The results were compared with the literature. RESULTS The study was comprised of 22 women and 18 men with a mean age of 50.6 years (age range, 33.1–75.2 yr). Preoperatively, 98% (n = 39) of the patients presented radicular pain, 88% (n = 35) of the patients presented with neck pain, 75% (n = 30) of the patients presented with a sensory deficit, and 45% (n = 18) of the patients presented with a motor deficit. Patients underwent operation at one level (n = 15), two levels (n = 23), or three levels (n = 2). One patient underwent operation bilaterally in a two-step procedure. In total, 68 cervical nerve roots were completely decompressed by this technique. On the basis of preoperative x-ray criteria of instability, two patients (5%) required graft arthrodesis, which was performed during the same surgery after the nerve root decompression. After a mean follow-up period of 4.3 years (range, 2.7–7.4 yr), 85% of the patients have no residual radicular pain, 94% of the patients have no more neck pain, 90% of the patients recovered from their sensory deficits, and 83% of the patients recovered from their motor deficits. According to Odom's criteria, 95% achieved an excellent or good outcome (Odom Grades I and II). No postoperative instability occurred. The transient and permanent morbidity rates were 7.5% (n = 3) and 2.5% (n = 1), respectively; one patient has permanent Horner's syndrome. CONCLUSION The technique of microsurgical cervical nerve root decompression by selective microforaminotomy via an anterolateral approach is safe and efficient for the treatment of spondylotic radiculopathy. The morbidity rate is low. Clinical results are good after a long-term follow-up period. This technique allows the preservation of cervical motion and spinal stability. The results compare favorably to those of the literature.

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Microsurgical Cervical Nerve Root Decompression by Anterolateral Approach

Operative Neurosurgery ◽

10.1227/01.neu.0000193521.98836.c5 ◽

2006 ◽

Vol 58 (suppl_1) ◽

pp. ONS-103-ONS-107 ◽

Cited By ~ 6

Author(s):

Michaël Bruneau ◽

Jan Frédérick Cornelius ◽

Bernard George

Keyword(s):

Minimally Invasive ◽

Nerve Root ◽

Cervical Radiculopathy ◽

Minimally Invasive Technique ◽

Invasive Technique ◽

Anterolateral Approach ◽

Cervical Nerve Root ◽

Cervical Nerve ◽

Neurosurgical Procedure ◽

Nerve Root Decompression

Abstract OBJECTIVE: Cervical radiculopathy caused by a posterolateral soft disc herniation or spondylosis is a common pathology. METHODS: Decompression of a stressed cervical nerve root is a routine neurosurgical procedure. Most of the time it is achieved through an anterior approach and, less frequently, through a posterior approach in specific indications. RESULTS: According to the principles that an anterolateral compression must directly be reached and that working in the vicinity of the vertebral artery is safe under visual control, we developed the anterolateral approach to the cervical intervertebral foramen and the nerve root using a minimally invasive technique to remove the offending process. CONCLUSION: Microsurgical cervical nerve root decompression by anterolateral approach is a minimally invasive technique, permitting one to remove the offending process staightforwardly. The disc and bone resections are minimal. This method avoids osteoarthrodesis or arthroplasty with disc prosthesis. This technique is efficient with good results and low morbidity.

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Cervical Dumbbell Intra-extradural Hemangioblastoma: Total Removal through the Lateral Approach: Technical Case Report

Neurosurgery ◽

10.1227/01.neu.0000154134.83900.05 ◽

2005 ◽

Vol 56 (3) ◽

pp. E625-E625 ◽

Cited By ~ 13

Author(s):

Cédric Barrey ◽

Michel Kalamarides ◽

Marc Polivka ◽

Bernard George

Keyword(s):

Vertebral Artery ◽

Nerve Root ◽

Histopathological Examination ◽

Lateral Approach ◽

Primary Control ◽

Cervical Nerve Root ◽

Cervical Nerve ◽

Dumbbell Tumor ◽

Computed Tomographic ◽

The Right

Abstract OBJECTIVE AND IMPORTANCE: Extradural hemangioblastomas account for 8 to 12% of all spinal hemangioblastomas. Among them, intra-extradural forms with a dumbbell extension are extremely rare. We report a case of intra-extradural hemangioblastoma involving the C6 cervical nerve root. CLINICAL PRESENTATION: The patient was a 31-year-old woman presenting with signs of myelopathy and C6 radiculopathy on the right side. A computed tomographic scan and magnetic resonance imaging demonstrated a dumbbell tumor that had developed through the C5–C6 intervertebral foramen. Angiography revealed a well-circumscribed mass with feeders from the vertebral artery and the deep cervical artery. INTERVENTION: The tumor was totally removed through the lateral approach, with control of the vertebral artery and sacrifice of the C6 cervical nerve root. Limited bone drilling to enlarge the foramen permitted us to reach and resect the intradural component. Histopathological examination confirmed the diagnosis of hemangioblastoma. Follow-up was uneventful. CONCLUSION: This is the sixth reported case of a cervical dumbbell hemangioblastoma investigated by computed tomographic scanning and MRI but the first one resected via the lateral approach. The lateral approach seems appropriate for surgical resection because it provides primary control of the vascular feeders and access to the extradural and intradural components.

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