Ultrasonic Total Uncinectomy: A Novel Technique for Complete Anterior Decompression of Cervical Nerve Roots

2014 ◽  
Vol 10 (4) ◽  
pp. 535-541 ◽  
Author(s):  
Peyman Pakzaban
Keyword(s):  
Vertebral Artery ◽  
Nerve Root ◽  
Uncinate Process ◽  
Foraminal Stenosis ◽  
Anterior Decompression ◽  
Nerve Roots ◽  
Cervical Nerve ◽  
Arm Pain ◽  
Nerve Root Injury ◽  
Cervical Nerve Roots

Abstract BACKGROUND: In standard anterior cervical diskectomy, complete resection of the uncinate process is not commonly attempted because of the risk of injury to the vertebral artery. This may result in incomplete decompression of the nerve root when there is severe osseous foraminal stenosis. OBJECTIVE: To demonstrate the feasibility of total uncinectomy with an ultrasonic bone dissector in patients with concomitant central and foraminal stenosis requiring anterior decompression and fusion. METHODS: A case series of patients with cervical radiculopathy or myeloradiculopathy who underwent single-level or multilevel ultrasonic total uncinectomy (UTU) in combination with anterior cervical diskectomy and fusion is presented. The uncinate process was amputated along its base with an ultrasonic bone dissector and removed en bloc to expose the cervical root and the vertebral artery. Data gathered in accordance with routine practice were analyzed retrospectively. RESULTS: Forty-four uncinate processes were resected in 38 patients. No UTU procedures were aborted because of technical difficulties, and no vertebral artery or nerve root injury occurred. Mean follow-up was 28 weeks (range, 14-37 weeks). Mean Neck Disability Index and Visual Analog Scale scores for neck and arm pain improved from 42%, 4.9%, and 6.8% to 23%, 2.6%, and 2.1%, respectively. Postoperative computed tomography and oblique radiographs revealed complete decompression of the neural foramen after UTU. CONCLUSION: UTU is a safe and effective technique for complete decompression of cervical nerve roots when the coexistence of central and foraminal pathology dictates an anterior approach. The surgical technique is described in detail.

scholarly journals Management Approach of Penetrating Vertebral Artery Injury with Concomitant Cervical Nerve Root Injury in Regional Hospital: Report of Two Cases

2018 ◽  
Vol 25 (1) ◽  
pp. 5-10
Author(s):  
Lam Yuk-Yu ◽  
Tsui Hon-For ◽  
Wong Hok-Leung ◽  
Chow Yuk-Yin
Keyword(s):  
Vertebral Artery ◽  
Nerve Root ◽  
Endovascular Intervention ◽  
Vertebral Artery Injury ◽  
Management Approach ◽  
Cervical Nerve Root ◽  
Cervical Nerve ◽  
Nerve Root Injury ◽  
Artery Injury ◽  
Root Injury

Penetrating vertebral artery injury is uncommon yet potentially fatal. We present two cases of penetrating vertebral artery injury with concomitant cervical nerve root injury managed in our centre. The first case was a young gentleman who suffered from neck injury by broken metal fragment. Cervical nerve root injury was suspected preoperatively. Massive bleeding from vertebral artery was encountered during wound exploration. It was managed by ligation, followed by retrograde endovascular embolisation. The second case was a young lady being assaulted with knife and fork over the neck. She was also suspected to have cervical nerve root injury preoperatively. Vascular control of vertebral artery was achieved with endovascular intervention. Subsequent operation for foreign body removal and nerve root repair was performed with minimal bleeding intraoperatively. Management approach of penetrating vertebral artery injury with concomitant cervical nerve root injury and the role of endovascular intervention were discussed.

scholarly journals Vascular Evaluation around the Cervical Nerve Roots during Ultrasound-Guided Cervical Nerve Root Block

2020 ◽  
Vol 4 (1) ◽  
pp. 18-22
Author(s):  
Shizumasa Murata ◽  
Hiroshi Iwasaki ◽  
Yuta Natsumi ◽  
Hiroshi Minagawa ◽  
Hiroshi Yamada
Keyword(s):  
Nerve Root ◽  
Ultrasound Guided ◽  
Nerve Roots ◽  
Cervical Nerve Root ◽  
Cervical Nerve ◽  
Nerve Root Block ◽  
Cervical Nerve Root Block ◽  
Cervical Nerve Roots

scholarly journals V. The abductor and adductor fibres of the recurrent laryngeal nerve

1892 ◽  
Vol 51 (308-314) ◽  
pp. 102-112 ◽  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Nerve Root ◽  
Laryngeal Nerve ◽  
Experimental Investigations ◽  
Nerve Fibres ◽  
Nerve Roots ◽  
Cervical Nerve ◽  
Cervical Nerve Roots

While engaged in certain experimental investigations in connexion with the cervical nerve roots of the dog (‘Roy. Soc. Proc.,’ 1892), the ease with which I found one could separate, in a nerve root, the different bundles of nerve fibres which are concerned with one function from those concerned with another, or even a bundle of nerve fibres destined for the supply of one muscle from one destined for the supply of another, led me to suppose that by exercising sufficient care, it might be possible to separate, in the same way, the abductor from the adductor fibres in the recurrent laryngeal nerve. It is a matter of clinical and pathological experience (Semon, Rosenbach) that in organic and progressive affections of this nerve the abductor fibres are prone to succumb before the adductors; but why this should be so is not at all clear.

scholarly journals Foraminal Ligaments Tether Upper Cervical Nerve Roots: A Potential Cause of Postoperative C5 Palsy

2020 ◽  
Vol 15 (01) ◽  
pp. e9-e15
Author(s):  
Andrew S. Jack ◽  
Brooks R. Osburn ◽  
Zane A. Tymchak ◽  
Wyatt L. Ramey ◽  
Rod J. Oskouian ◽  
...  
Keyword(s):  
Nerve Root ◽  
Repeated Measures ◽  
Statistical Significance ◽  
Nerve Roots ◽  
Cervical Nerve ◽  
C5 Palsy ◽  
Before And After ◽  
Upper Cervical ◽  
Cervical Foraminotomy ◽  
Cervical Nerve Roots

Abstract Background Nerve root tethering upon dorsal spinal cord (SC) migration has been proposed as a potential mechanism for postoperative C5 palsy (C5P). To our knowledge, this is the first study to investigate this relationship by anatomically comparing C5–C6 nerve root translation before and after root untethering by cutting the cervical foraminal ligaments (FL). Objective The aim of this study is to determine if C5 root untethering through FL cutting results in increased root translation. Methods Six cadaveric dissections were performed. Nerve roots were exposed via C4–C6 corpectomies and supraclavicular brachial plexus exposure. Pins were inserted into the C5–C6 roots and adjacent foraminal tubercle. Translation was measured as the distance between pins after the SC was dorsally displaced 5 mm before and after FL cutting. Clinical feasibility of FL release was examined by comparing root translation between standard and extended (complete foraminal decompression) foraminotomies. Translation of root levels before and after FL cutting was compared by two-way repeated measures analysis of variance. Statistical significance was set at 0.05. Results Significantly more nerve root translation was observed if the FL was cut versus not-cut, p = 0.001; no difference was seen between levels, p = 0.33. Performing an extended cervical foraminotomy was technically feasible allowing complete FL release and root untethering, whereas a standard foraminotomy did not. Conclusion FL tether upper cervical nerve roots in their foramina; cutting these ligaments untethers the root and increases translation suggesting they could be harmful in the context of C5P. Further investigation is required examining the value of root untethering in the context of C5P.

Anatomical relationships between the V2 segment of the vertebral artery and the cervical nerve roots

2006 ◽  
Vol 5 (5) ◽  
pp. 440-442 ◽  
Author(s):  
Sergio Paolini ◽  
Giuseppe Lanzino
Keyword(s):  
Vertebral Artery ◽  
Lower Margin ◽  
Nerve Roots ◽  
Neural Foramen ◽  
Cervical Nerve ◽  
Dural Sac ◽  
Relative Safety ◽  
Predictable Pattern ◽  
The Relationship ◽  
Cervical Nerve Roots

Object During surgical procedures focused on the cervical nerve roots, the surgeon works in proximity to the V2 segment of the vertebral artery (VA). Depending on the specific surgical approach, it may be necessary to identify, expose, or mobilize the artery. In most cases, the artery may be left undisturbed. To reduce the risk of iatrogenic injury to the V2 segment during anterior and anterolateral approaches to the cervical spine, the authors analyzed the relationship between the V2 segment and the proximal segment of the C3–6 nerve roots. Methods Six cadaveric cervical spines (12 sides) were fixed with formalin, injected with red and blue latex, and investigated intraoperatively using different magnifications (× 3–40). The VA rested on the anteromedial surface of the cervical nerve roots at the level of each intertransverse space. The exiting nerve roots intersected the VA at a distance ranging from 4.5 to 8.1 mm (mean 6.3 ± 1.06 mm) from the dural sac. The distance was slightly shorter at cephalad levels, suggesting that the artery is more posteriorly and medially situated at those levels. Arterial pedicles anchored the VA to the cervical nerve roots at various levels. These arteries gave rise to purely radicular, ligamentous, and medullary branches without a predictable pattern. After reaching the nerve roots on their lower margin, the nonligamentous branches pierced the radicular dural sheath within the neural foramen at a distance of 2 to 4 mm from the VA. Conclusions Proximal-to-distal dissection of a cervical nerve root may proceed with relative safety for at least 4 mm. The V2 segment of the VA gives rise to at least one radicular arterial pedicle between C-4 and C-6. These trunks give rise to purely radicular, ligamentous, and medullary branches in an unpredictable pattern.

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

2019 ◽  
Vol 31 (6) ◽  
pp. 831-834 ◽  
Author(s):  
Anand H. Segar ◽  
Alexander Riccio ◽  
Michael Smith ◽  
Themistocles S. Protopsaltis
Keyword(s):  
Vertebral Artery ◽  
High Speed ◽  
Thermal Injury ◽  
Technical Note ◽  
Uncinate Process ◽  
Foraminal Stenosis ◽  
Cervical Kyphosis ◽  
Kyphosis Correction ◽  
Direct Injury ◽  
High Speed Burr

Total uncinate process resection or uncinectomy is often required in the setting of severe foraminal stenosis or cervical kyphosis correction. The proximity of the uncus to the vertebral artery, nerve root, and spinal cord makes this a challenging undertaking. Use of a high-speed burr or ultrasonic bone dissector can be associated with direct injury to the vertebral artery and thermal injury to the surrounding structures. The use of an osteotome is a safe and efficient method of uncinectomy. Here the authors describe their technique, which is illustrated with an intraoperative video.

Dissection of the vertebral artery with cervical nerve root lesions

1996 ◽  
Vol 243 (2) ◽  
pp. 121-125 ◽  
Author(s):  
Andreas Hetzel ◽  
Wiltrud Berger ◽  
Martin Schumacher ◽  
Carl Hermann Lücking
Keyword(s):  
Vertebral Artery ◽  
Nerve Root ◽  
Cervical Nerve Root ◽  
Cervical Nerve
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