STUDY DESIGN: Cadaveric human cervical spine anatomic study using posterior lateral mass screw-rod instrumentation to assess foraminal enlargement via distraction techniques. OBJECTIVES: To determine the role of posterior cervical distraction on foraminal dimensions and to ascertain the impact of this technique on segmental kyphosis. SUMMARY OF BACKGROUND DATA: Management of cervical spondylotic radiculopathy includes removal of offending compressive structures and enlarging the neuroforamen via anterior discectomy with interbody fusion or posterior laminoforaminotomy. METHODS: Six human cervical spines were prepared and posterior exposure performed. Lateral mass screws were inserted from C5 to C7 and a longitudinal rod attached. Distraction was applied between the screw heads at 2 mm intervals and accuracy confirmed with digitized calipers. Pre- and postdistraction computed tomography was performed including axial and reformatted images. Foraminal area, height, and width and sagittal alignment and disc heights were evaluated. RESULTS: The results suggest that minimal posterior distraction of 4 to 6 mm at C5-C6 and C6-C7 may enlarge the neuroforamen by 10 to 18 mm. Foraminal height and width increased minimally from baseline to maximum distraction; however, these measurements did not reach statistical significance at either level. A decrease of segmental lordosis at C5-C6 was noted from baseline to 8 mm of distraction. Statistically significant kyphosis from baseline was present at 6 mm of distraction leading to overall 5.2 +/- 1.4degrees change in alignment. At C6-C7, statistically significant kyphosis was not present until 8 mm of distraction (4.62 +/- 2.23degrees). CONCLUSIONS: This study suggests that posterior cervical instrumented distraction in the setting of foraminal stenosis is a reasonable supplement to direct laminoforaminotomy and nerve root decompression. Distraction leads to minimal segmental kyphosis, allowing this technique to serve as an adjunct for additional foraminal enlargement.
STUDY DESIGN: Cadaveric human cervical spine anatomic study using posterior lateral mass screw-rod instrumentation to assess foraminal enlargement via distraction techniques. OBJECTIVES: To determine the role of posterior cervical distraction on foraminal dimensions and to ascertain the impact of this technique on segmental kyphosis. SUMMARY OF BACKGROUND DATA: Management of cervical spondylotic radiculopathy includes removal of offending compressive structures and enlarging the neuroforamen via anterior discectomy with interbody fusion or posterior laminoforaminotomy. METHODS: Six human cervical spines were prepared and posterior exposure performed. Lateral mass screws were inserted from C5 to C7 and a longitudinal rod attached. Distraction was applied between the screw heads at 2 mm intervals and accuracy confirmed with digitized calipers. Pre- and postdistraction computed tomography was performed including axial and reformatted images. Foraminal area, height, and width and sagittal alignment and disc heights were evaluated. RESULTS: The results suggest that minimal posterior distraction of 4 to 6 mm at C5-C6 and C6-C7 may enlarge the neuroforamen by 10 to 18 mm. Foraminal height and width increased minimally from baseline to maximum distraction; however, these measurements did not reach statistical significance at either level. A decrease of segmental lordosis at C5-C6 was noted from baseline to 8 mm of distraction. Statistically significant kyphosis from baseline was present at 6 mm of distraction leading to overall 5.2 +/- 1.4degrees change in alignment. At C6-C7, statistically significant kyphosis was not present until 8 mm of distraction (4.62 +/- 2.23degrees). CONCLUSIONS: This study suggests that posterior cervical instrumented distraction in the setting of foraminal stenosis is a reasonable supplement to direct laminoforaminotomy and nerve root decompression. Distraction leads to minimal segmental kyphosis, allowing this technique to serve as an adjunct for additional foraminal enlargement.
Authors: James Meacock; Moritz Schramm; Senthil Selvanathan; Stuart Currie; Deborah Stocken; David Jayne; Simon Thomson Journal: Neuroradiology Date: 2021-01-04 Impact factor: 2.804
Authors: Avinash G Patwardhan; Saeed Khayatzadeh; Robert M Havey; Leonard I Voronov; Zachary A Smith; Olivia Kalmanson; Alexander J Ghanayem; William Sears Journal: Eur Spine J Date: 2017-11-06 Impact factor: 3.134
Authors: Zachary A Smith; Saeed Khayatzadeh; Joshua Bakhsheshian; Michael Harvey; Robert M Havey; Leonard I Voronov; Muturi G Muriuki; Avinash G Patwardhan Journal: Eur Spine J Date: 2016-02-01 Impact factor: 3.134
Authors: Ali Fahir Ozer; Salim Senturk; Mert Ciplak; Tunc Oktenoglu; Mehdi Sasani; Emrah Egemen; Onur Yaman; Tuncer Suzer Journal: Asian Spine J Date: 2016-08-16