Anterior Cervical Foraminotomy

Chapter Synopsis

This chapter describes in detail the surgical techniques and merits of transcorporeal anterior cervical microforaminotomy for cervical radiculopathy. This procedure involves a modification of the previous anterior microforaminotomy in terms of its medial starting point and tunneling on the upper vertebral body.

Important Points

Transcorporeal anterior cervical microforaminotomy allows for direct decompression of the cervical nerve root while preserving the uncovertebral joint and intervertebral disk integrity and avoiding injury to the vertebral artery and cervical sympathetic chain.

Indications include cervical radiculopathy secondary to compression anterior or medial to the cervical nerve root.

Contraindications include bilateral foraminal stenosis, predominant axial neck pain, signs suggestive of infection, mechanical instability, and cervical myelopathy.

Clinical and Surgical Pearls

Foraminal magnetic resonance imaging and reconstructed computed tomography images perpendicular to the cervical foramen can help identify and define the foraminal disease.

Typically, the anterior cervical exposure to the upper vertebral body and affected disk space is approached from the side corresponding to the radiculopathy.

The longus colli muscle is dissected from its medial border. The starting point for microscopic drilling is just lateral to the medial margin of the longus colli muscle at the midvertebral body level heading toward the posterior tip of the uncinate process.

In the case of spondylotic foraminal stenosis, the ideal decompression is limited by the upper and lower pedicle and full lateral bony decompression to the transverse foramen.

In the case of soft disk herniation, the surgeon must excise the posterior longitudinal ligament to explore for any residual free fragments penetrating the ligament.

Clinical and Surgical Pitfalls

Care should be taken not to violate the upper vertebral end plate because that can result in late intervertebral disk collapse and narrowing.

Uncertainty of the sagittal orientation tends to bring about more caudally directed drilling. Usually, a 15-degree caudal angle on the sagittal plane is appropriate.

Tilting the patient to the proper angle can place the desired drill hole perpendicular to the ground in both the sagittal and axial planes.

In the case of the extruded disk, a careful search for additional extruded fragments must be performed if intraoperative findings do not confirm preoperative imaging results.