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Cervical Radiculopathy
Published in Kelechi Eseonu, Nicolas Beresford-Cleary, Spine Surgery Vivas for the FRCS (Tr & Orth), 2022
Kelechi Eseonu, Nicolas Beresford-Cleary
ACDF remains the gold standard in the surgical treatment of cervical radiculopathy and has an extremely high success rate with a single-level disease. In cases of foraminal soft disc herniation causing single-level radiculopathy, decompression of the nerve root via a posterior foraminotomy (either open or minimally invasive) has reported good outcomes. Contraindications to posterior foraminotomy include patients with large central disc herniation, cervical myelopathy, instability, OPLL and those with kyphotic deformity.
Neurosurgery: Minimally invasive neurosurgery
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Geriatric Neuroanesthesia, 2019
Charu Mahajan, Indu Kapoor, Hemanshu Prabhakar
This is another minimally invasive decompression surgery that helps to relieve the pressure on the spinal cord or nerve roots. Compared to open cervical foraminotomy, it is associated with lower blood loss, less pain, and shorter duration of hospital stay. These procedures are usually carried out under general endotracheal anesthesia. The intraoperative evoked potential monitoring requires total intravenous-based anesthesia with omission of muscle relaxants. The anterior cervical foraminotomy helps to treat ventral radiculopathy without the need for discectomy, obviating the need for any arthrodesis or neck collar. Injury may occur to nerve root, blood vessels, or to sympathetic chain, resulting in Horner syndrome. Posterior cervical microforaminotomy is used to treat foraminal stenosis due to degenerative changes such as osteophytes or lateral disc herniation (29). It may be carried out in the prone or sitting position. Injury to dura, nerve root, or blood vessels may occur. Vertebral artery injury is a dreaded complication and requires control with gelfoam packing. In an uneventful case, patients are woken and trachea extubated at the end of surgery.
The neck
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Foraminotomy Foraminotomy (enlarging the IV foramen) through a posterior approach, may occasionally be indicated if there is isolated referred pain in the upper limb and/or radiculopathy, revealed on MRI as foraminal narrowing and nerve root compression. It is a very successful operation for pain relief, but only part of the facet joint is removed so as not to leave this segment unstable. Patients should be warned that pre-existing axial neck pain might not be eliminated and that further surgery may be required as the adjacent segments may go on to develop symptomatic disc degeneration in the future.
The Current State of Cervical Endoscopic Spine Surgery: an Updated Literature Review and Technical Considerations
Published in Expert Review of Medical Devices, 2020
This technique is the classical posterior endoscopic decompression technique for cervical radiculopathy [33,38]. An efficient foraminal decompression can be achieved through a focal posterior foraminal decompression window (Figure 1C). Unlike the anterior procedures, the potential risk of injury to critical structures, including the trachea, esophagus, and carotid artery, is minimized. This procedure is more useful when the pathology is located at the foraminal or lateral to the myelon’s lateral margin. The patient undergoes the process in a prone position under general or local anesthesia. An approach needle and dilators are sequentially inserted to the laminofacet junction or ‘Y-point.’ A bevel-ended working sheath is inserted over the dilators, and a working channel endoscope is then placed down to the laminofacet junction. The surgical field is prepared with a forceps and radiofrequency. After confirming the ‘Y-point,’ foraminal unroofing is performed using various endoscopic burrs and punches under endoscopic visualization. Endoscopic foraminotomy is delivered from the cranial lamina to the caudal lamina, from the medial edge of the facet to the lateral half of the facet joint. After removal of the ligamentum flavum, the thecal sac and exiting nerve root can be visualized. A careful dissection of the exiting nerve root and surrounding soft tissues as well as a selective discectomy can be performed. The nerve root can be retracted using the bevel-ended tip of the working cannula, and the exposed extruded disc can be removed using a disc forceps and supplementary radiofrequency.
Comparing the postoperative results of single-level anterior cervical discectomy and fusion, cervical disc prosthesis and minimal invasive posterior cervical disc surgery
Published in British Journal of Neurosurgery, 2020
Patients who had undergone single-level cervical disc surgery for herniation at the İstanbul Yeni Yüzyıl University Gaziosmanpaşa Hospital between February 2015 and December 2017 were evaluated. The study was performed according to the guidelines of the local ethics committee which conforms to the Helsinki Declaration. This evaluation was performed on patients who had presented with single-level disc herniation between C3 and C7 and had undergone surgery with an anterior or posterior approach. A disc prosthesis or a polyetheretherketone (PEEK) cage was used for fusion following discectomy in the group that underwent anterior surgery. Posterior minimal invasive foraminotomy and discectomy was used in the group that underwent posterior surgery. The procedure is determined according to the preference and experience of the surgeon. The surgical procedures are similar to those reported in the literature for ACDF,10 CDP11 and MI-PCD.17
Percutaneous posterior full-endoscopic cervical foraminotomy and discectomy: a finite element analysis and radiological assessment
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2020
Wencan Ke, Jinggang Zhi, Wenbin Hua, Bingjin Wang, Saideng Lu, Lina Fan, Li Li, Cao Yang
Recently, a minimally invasive procedure known as posterior full-endoscopic cervical foraminotomy and discectomy (PECFD) has been recommended (Ruetten et al. 2008). PECFD surgery is a minimally invasive technique that is generally regarded as an effective and safe supplement to conventional fusion procedures. In patients with unilateral cervical radiculopathy caused by focal lesions of the intervertebral foramen or soft-disc herniations, total discectomy, and fusion are not required and minimally invasive surgery may be more suitable. A previous biomechanical study suggested that segmental mobility increased with the degree of the facet resection after foraminotomy; however, segmental hypermobility of the cervical spine can be prevented if less than 50% of the facet is resected (Skovrlj et al. 2014). Although previous studies have reported that the stability does not appear to be significantly affected by PECFD, the recurrence of postoperative neck or back pain due to degenerative changes at the index level or another level due to degenerative changes remains an alarming problem (Ruetten et al. 2008; Joachim et al. 2016).