Steven J McAnany1, Sheeraz A Qureshi2. 1. Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia. 2. Department of Orthopedics, Mount Sinai Medical Center, New York, NY.
Abstract
INTRODUCTION: The minimally invasive posterior cervical foraminotomy, a motion-preserving procedure, is an excellent treatment for patients with unilateral radiculopathy secondary to a laterally located herniated disc or foraminal stenosis. STEP 1 POSITION THE PATIENT VIDEO 1: Place the patient in a prone position on a Jackson table with 6 posts and with the head resting comfortably on a soft facial pillow, and tape the shoulders down to provide traction to the skin and help with fluoroscopic visualization of the lower cervical levels. STEP 2 PERFORM THE SKIN INCISION: Make the skin incision adjacent to the spinous process on the side of the abnormality over the operative level. STEP 3 USE TUBULAR DILATORS TO MAKE A WORKING PORTAL: Use sequential dilators to create a working portal and secure the working tube overlying the lamina-facet junction of the operative level. STEP 4 PERFORM THE LAMINOFORAMINOTOMY VIDEO 2: Perform the laminoforaminotomy with the use of a high-speed drill and a Kerrison rongeur to create a working window into the foramen. STEP 5 PERFORM THE FORAMINAL DECOMPRESSION VIDEO 3: Use a nerve hook to superiorly retract the nerve root, and perform a discectomy and decompression. STEP 6 WOUND CLOSURE AND POSTOPERATIVE CARE: Obtain hemostasis with electrocautery or hemostatic foam and close the wound with a standard layered closure. RESULTS: A systematic review and meta-analysis of studies on open or minimally invasive surgical (MIS) techniques for posterior cervical foraminotomy showed a pooled clinical success rate of 92.7% for the 509 patients managed with the open technique and 94.9% for the 208 patients who had the MIS technique; the difference was not significant (p = 0.418)2.
INTRODUCTION: The minimally invasive posterior cervical foraminotomy, a motion-preserving procedure, is an excellent treatment for patients with unilateral radiculopathy secondary to a laterally located herniated disc or foraminal stenosis. STEP 1 POSITION THE PATIENT VIDEO 1: Place the patient in a prone position on a Jackson table with 6 posts and with the head resting comfortably on a soft facial pillow, and tape the shoulders down to provide traction to the skin and help with fluoroscopic visualization of the lower cervical levels. STEP 2 PERFORM THE SKIN INCISION: Make the skin incision adjacent to the spinous process on the side of the abnormality over the operative level. STEP 3 USE TUBULAR DILATORS TO MAKE A WORKING PORTAL: Use sequential dilators to create a working portal and secure the working tube overlying the lamina-facet junction of the operative level. STEP 4 PERFORM THE LAMINOFORAMINOTOMY VIDEO 2: Perform the laminoforaminotomy with the use of a high-speed drill and a Kerrison rongeur to create a working window into the foramen. STEP 5 PERFORM THE FORAMINAL DECOMPRESSION VIDEO 3: Use a nerve hook to superiorly retract the nerve root, and perform a discectomy and decompression. STEP 6 WOUND CLOSURE AND POSTOPERATIVE CARE: Obtain hemostasis with electrocautery or hemostatic foam and close the wound with a standard layered closure. RESULTS: A systematic review and meta-analysis of studies on open or minimally invasive surgical (MIS) techniques for posterior cervical foraminotomy showed a pooled clinical success rate of 92.7% for the 509 patients managed with the open technique and 94.9% for the 208 patients who had the MIS technique; the difference was not significant (p = 0.418)2.
Authors: Steven J McAnany; Jun S Kim; Samuel C Overley; Evan O Baird; Paul A Anderson; Sheeraz A Qureshi Journal: Spine J Date: 2015-01-24 Impact factor: 4.166