Failed anterior cervical foraminotomy

Object. Anterior cervical foraminotomy has been advocated as a procedure that preserves the motion segment while treating radiculopathy due to degenerative cervical disc disease. Because the medical literature contains no long-term follow up or randomized studies related to this procedure, the authors reviewed their results, specifically examining cases of failure to determine the efficacy of the approach. Methods. The authors identified 23 patients in whom unilateral cervical radiculopathy due to degenerative cervical disc disease was refractory to conservative therapy and in whom anterior cervical foraminotomy was performed between 1998 and 2000. The procedure involves ipsilateral exposure, microsurgical removal of the uncovertebral joint to identify the nerve root, and partial removal of the lateral anulus and or disc fragments. Data in those patients who underwent reoperation(s) were reviewed specifically for the procedure type, interval between index procedure and reoperation, and whether multiple procedures were performed. Of the 23 patients, 30% required at least one additional procedure. A good or excellent outcome at last follow-up examination was achieved in only 12 patients. Conclusions. In the current study the authors found a reoperation rate that is considerably higher than that in most series of anterior cervical surgery for radiculopathy. The presumed benefit of anterior cervical foraminotomy is preservation of the disc interspace; however, in this study, a significant number of patients failed to experience a satisfying outcome. Currently the authors do not recommend anterior cervical foraminotomy as a stand-alone procedure.

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Anterior surgery for cervical disc disease

Journal of Neurosurgery ◽

10.3171/jns.1980.53.1.0012 ◽

1980 ◽

Vol 53 (1) ◽

pp. 12-19 ◽

Cited By ~ 124

Author(s):

L. Dade Lunsford ◽

David J. Bissonette ◽

David S. Zorub

Keyword(s):

Surgical Techniques ◽

Cervical Disc ◽

Cervical Canal ◽

Cervical Disc Disease ◽

Disc Disease ◽

Duration Of Symptoms ◽

Content Type ◽

Cervical Surgery ◽

Anterior Cervical Surgery

✓ The results of anterior cervical surgery for treatment of cervical spondylotic myelopathy (CSM) are assessed 1 to 7 years postoperatively in 32 patients. At follow-up review, 50% were improved after surgery and 50% were unimproved or had deteriorated in spite of surgery. The results could not be statistically linked to the patients' age, duration of symptoms, severity of myelopathy, cervical canal size, or the performance of single- or multiple-level operations. Various anterior surgical techniques were used, but none proved to have superior results. The results in this series failed to surpass the results obtained by others for conservative treatment alone. In many cases, symptoms of CSM progressed despite the intervention of anterior cervical surgery.

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Cervical arthroplasty after previous surgery: results of treating 24 discs in 15 patients

Journal of Neurosurgery Spine ◽

10.3171/spi.2005.3.5.0335 ◽

2005 ◽

Vol 3 (5) ◽

pp. 335-341 ◽

Cited By ~ 48

Author(s):

Lali H. S. Sekhon ◽

William Sears ◽

Neil Duggal

Keyword(s):

Interbody Fusion ◽

Cervical Disc ◽

Cervical Disc Disease ◽

Disc Disease ◽

Cervical Arthroplasty ◽

Content Type ◽

Anterior Interbody Fusion ◽

Posterior Foraminotomy ◽

Fine Print

Object. The potential role of cervical arthroplasty in patients who have undergone previous cervical surgery is unknown. The authors performed a prospective study involving nonrandomized clinical and radiological assessment in patients who had undergone either previous posterior cervical foraminotomy or anterior interbody fusion and who suffered new or persistent arm/neck symptoms related to neural compression. Methods. During a 30-month period, 15 patients who had previously undergone cervical spinal surgery underwent cervical arthroplasty that involved placement of the Bryan disc for neck or arm symptoms related to cervical disc disease. A total of 24 devices were implanted. Six of the 15 patients had undergone a previous posterior foraminotomy, and in nine cases an anterior interbody fusion had been perfomed at some stage prior to surgery. Clinical and radiological evaluations were performed preoperatively and after surgery to assess outcomes. A total of 24 arthroplasties were performed encompassing between one and three levels. There were no major perioperative complications or immediate device-related failures. Two patients were lost to follow up. The follow-up period ranged from 12 to 43 months (mean 24.2 ± 10.5 months). Good results were obtained in all cases as reflected by an increase in the visual analog scale score of 6.4 in terms of neck/arm pain (p < 0.05). There was no difference in Oswestry Disability Index scores for neck pain (p > 0.05) and no patient required surgery at the same level. In one patient hypermobility developed with internal subluxation of the device, which suggested a compromise adjacent to a two-level fusion at 21 months. The segment was hypermobile preoperatively. The patient has experienced recurrent neck pain but otherwise remains clinically well and has not required revision surgery to date. Conclusions. Insertion of the Bryan artificial cervical disc in patients who have previously undergone cervical fusion or posterior foraminotomy, in general, appears to be safe. It provided encouraging early clinical results, although patients with preoperative hypermobility should be treated with caution. Issues such as accelerated device-related wear and the use of arthroplasty after aggressive facetectomy resection will need further study; however, in carefully selected patients who have undergone previous surgery cervical arthroplasty may provide an additional tool in the management of cervical disc disease.

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The future in the care of the cervical spine: interbody fusion and arthroplasty

Journal of Neurosurgery Spine ◽

10.3171/spi.2004.1.2.0155 ◽

2004 ◽

Vol 1 (2) ◽

pp. 155-159 ◽

Cited By ~ 64

Author(s):

Praveen V. Mummaneni ◽

Regis W. Haid

Keyword(s):

Adjacent Segment Degeneration ◽

Cervical Disc ◽

Adjacent Segment ◽

Cervical Fusion ◽

Cervical Disc Disease ◽

Disc Disease ◽

Cervical Arthroplasty ◽

Content Type ◽

Fine Print

✓ In the past 50 years tremendous advances have been made in the treatment of cervical disc disease with cervical fusion. Fusion rates have surpassed 95% after application of anterior cervical implants. Adjacent-segment degeneration, however, has plagued the long-term clinical success of cervical fusion. Cervical arthroplasty has been introduced to maintain cervical motion and potentially avoid or minimize adjacent-segment degeneration. If cervical arthroplasty is successful, the long-term results of surgery for cervical disc disease may improve; however, there are associated drawbacks that must be overcome. Implant wear, fatigue, and failure have been reported in cases of large-joint arthroplasty, and research is underway to limit these problems in cervical arthroplasty. In this article the authors trace the evolution of cervical fusion and the new technique of cervical arthroplasty. The nomenclature of cervical arthroplasty will also be introduced.

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Use of a polymethylmethacrylate cervical cage in the treatment of single-level cervical disc disease

Journal of Neurosurgery Spine ◽

10.3171/spi.2005.3.1.0024 ◽

2005 ◽

Vol 3 (1) ◽

pp. 24-28 ◽

Cited By ~ 20

Author(s):

Jyi-Feng Chen ◽

Chieh-Tsai Wu ◽

Sai-Cheung Lee ◽

Shih-Tseng Lee

Keyword(s):

Cancellous Bone ◽

Disc Herniation ◽

Interbody Fusion ◽

Cervical Disc Herniation ◽

Cervical Disc ◽

Cervical Disc Disease ◽

Disc Disease ◽

Content Type ◽

Single Level ◽

Fine Print

Object. Polymethylmethacrylate (PMMA) bone cement has been used as a spacer in the treatment of patients with cervical disc disease with good long-term outcomes, but solid bone fusion has not been demonstrated in all cases. To achieve cervical interbody fusion, the authors designed a modified PMMA cervical cage that they filled with spongy bone for the treatment of single-level cervical disc herniation. Methods. Sixty-three patients underwent anterior cervical microdiscectomy and implantation of a PMMA cervical cage filled with autograft cancellous bone and were followed for a minimum of 2 years. The fusion rates were 90.5 and 100% at the 6- and 12-month follow-up examinations, respectively. The mean intervertebral disc height gain was 3.4 ± 1.9 mm when preoperative and 24-month postoperative values were compared. Neck pain, measured using the Huskissan visual analog scale (0 mm, no pain; 100 mm, worst possible pain), decreased from 71 ± 13 mm at preoperative baseline to 28 ± 17 at 6, 23 ± 19 at 12, and 31 ± 19 mm at 24 months. Based on the same scale, radicular pain decreased from 83 ± 15 mm at preoperative baseline to 24 ± 11 at 6, 27 ± 13 at 12, and 22 ± 11 mm at 24 months. The self-rated clinical outcome was excellent in 45 (71.4%) and good in 18 (28.6%) of the 63 patients. Conclusions. The autograft cancellous bone—filled PMMA cage is safe and effective for cervical interbody fusion in the treatment of single-level cervical disc herniation and monoradiculopathy.

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Microsurgical anterior cervical foraminotomy (uncinatectomy) for cervical disc herniation

Journal of Neurosurgery Spine ◽

10.3171/spi.2001.94.1.0121 ◽

2001 ◽

Vol 94 (1) ◽

pp. 121-125 ◽

Cited By ~ 6

Author(s):

Al O. Taşçioǧlu ◽

Ayhan Attar ◽

Beliz Taşçioǧlu

Keyword(s):

Long Term Results ◽

Cervical Disc ◽

Disc Space ◽

Content Type ◽

Long Term Follow Up ◽

Disc Herniations ◽

Cervical Foraminotomy ◽

Fine Print

✓ The authors present the long-term follow-up results in three cases in which pure lateral disc herniations were surgically treated via an anterior foraminotomy (uncinatectomy) that avoided entering the disc space. The pertinent anatomical details essential for a safe approach are discussed in light of nine cadaveric neck dissections of every segment between C-1 and C-7. The surgical technique was initially studied in the cadaveric specimens and then applied in patients. The long-term results (> 2 years) in the first three patients are as good as our short-term results in another eight cases.

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