Surgical options to address the symptoms and signs of unilateral cervical radiculopathy include posterior foraminotomies, anterior foraminotomies, anterior cervical discectomy and fusion, and cervical disk arthroplasty. Foraminotomies are often performed in combination with larger surgical procedures such as fusion, disk arthroplasty, and laminectomy. In these cases, the more extensive surgical exposure makes the procedure technically easier to perform. Minimally invasive posterior and anterior cervical foraminotomies for the treatment of cervical radiculopathy is the focus of this chapter. The goal of both approaches is to address the compressive pathology while minimizing tissue disruption and alteration of cervical spine biomechanics. Of these 2 approaches, the posterior cervical foraminotomy is the most common. The classic posterior approach was described by Spurling and Scolville in 1944. Since then, several variations have been described, all having the shared goal of decompressing the nerve root at the cervical neural foramen.1 Minimally invasive laminoforaminotomy provides access to and visualization of the cervical neural foramen through muscle-sparing techniques in order to decrease the pain and morbidity associated with traditional open surgery while maintaining the same efficacy as the open procedure. The anterior cervical microforaminotomy, often referred to as the Jho procedure, was first described in 1996. It was developed to try to address the known limitations and potential pitfalls of classic anterior and posterior cervical procedures.2 The technique involves accessing the compressive pathology through the anterior uncovertebral junction. Once access is achieved, the soft disk and/or bone spurs that compose the compressive pathology are excised. The procedure has evolved over time to include 4 basic variations of the technique and favor the utilization of an endoscope vs the operating microscope for visualization.
All Science Journal Classification (ASJC) codes
- Orthopedics and Sports Medicine