J Korean Neurosurg Soc.  2014 Aug;56(2):114-120. 10.3340/jkns.2014.56.2.114.

Cervical Cord Decompression Using Extended Anterior Cervical Foraminotomy Technique

• Kim SD
• Ha HG
• Lee CY
• Kim HW
• Jung CK
• Kim JH

• KMID: 1956513
• DOI: http://doi.org/10.3340/jkns.2014.56.2.114

Abstract

OBJECTIVE
At present, gold-standard technique of cervical cord decompression is surgical decompression and fusion. But, many complications related cervical fusion have been reported. We adopted an extended anterior cervical foraminotomy (EACF) technique to decompress the anterolateral portion of cervical cord and report clinical results and effectiveness of this procedure.
METHODS
Fifty-three patients were operated consecutively using EACF from 2008 to 2013. All of them were operated by a single surgeon via the unilateral approach. Twenty-two patients who exhibited radicular and/or myelopathic symptoms were enrolled in this study. All of them showed cervical cord compression in their preoperative magnetic resonance scan images.
RESULTS
In surgical outcomes, 14 patients (64%) were classified as excellent and six (27%), as good. The mean difference of cervical cord anterior-posterior diameter after surgery was 0.92 mm (p<0.01) and transverse area was 9.77 mm2 (p<0.01). The dynamic radiological study showed that the average post-operative translation (retrolisthesis) was 0.36 mm and the disc height loss at the operated level was 0.81 mm. The change in the Cobb angle decreased to 3.46, and showed slight kyphosis. The average vertebral body resection rate was 11.47%. No procedure-related complications occurred. Only one patient who had two-level decompression needed anterior fusion at one level as a secondary surgery due to postoperative instability.
CONCLUSIONS
Cervical cord decompression was successfully performed using EACF technique. This procedure will be an alternative surgical option for treating cord compressing lesions. Long-term follow-up and a further study in larger series will be needed.

Keyword

Cervical spondylosis; Anterior cervical foraminotomy; Spinal cord compression; Cervical myelopathy

MeSH Terms

Decompression*
Decompression, Surgical
Follow-Up Studies
Foraminotomy*
Humans
Kyphosis
Spinal Cord Compression
Spondylosis

Figure

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  Fig. 1 Sketch diagram of measurement of vertebral body resection area (A), AP diameter (B), and transverse area (C) by TeraRecon Workstation.

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  Fig. 2 A and B : Axial, T2-weighted, MRI scans demonstrated C4-5, C5-6 disc herniation with cervical cord compression. C : Sagittal, T2-weighted MRI. D : Sagittal, cervical CT showed ossification of posterior longitudinal ligaments. E and F : Axial, T2-weighted, MRI scans showed excellent decompression after surgery. G : Sagittal T2-weighted, MRI scans. H : Posto-perative cervical 3D CT showed microforaminotomy hole at C4-5, C5-6, Rt.

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  Fig. 3 Flexion (A) and extension (B) dynamic roentgenograms of the cervical spine, obtained 6 weeks after surgery, confirming normal motion at the C4-5, C5-6 level.

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