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Review
. 2020 Mar;6(1):205-209.
doi: 10.21037/jss.2019.12.04.

Safety and efficacy of direct nerve root decompression via anterior cervical discectomy and fusion with uncinectomy for cervical radiculopathy

Michael M Safaee  1 , Noah M Nichols  1 , Ketan Yerneni  2 , Yalan Zhang  1 , K Daniel Riew  3 , Lee A Tan  1
Affiliations
Review

Safety and efficacy of direct nerve root decompression via anterior cervical discectomy and fusion with uncinectomy for cervical radiculopathy

Michael M Safaee et al. J Spine Surg. 2020 Mar.

Abstract

Cervical radiculopathy is a common spinal condition associated with pain, sensory disturbances, and motor weakness. Symptoms often can be attributable to either disc herniation and/or bony foraminal stenosis due to uncinate hypertrophy. Posterior cervical foraminotomy and conventional anterior cervical discectomy and fusion (ACDF) represent the mainstay of treatment. In patients with severe bony foraminal stenosis, posterior foraminotomy and standard ACDF without complete resection of uncinate process may result in incomplete decompression. ACDF with uncinectomy allows for complete and direct decompression of the exiting nerve root, and may lead to improved clinical outcome in appropriately selected patients. We describe the technique for ACDF with uncinectomy and report the clinical outcome in a consecutive series of patients.

Keywords: Anterior foraminotomy; anterior cervical discectomy and fusion (ACDF); uncinate process resection; uncinectomy.

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Conflict of interest statement

Conflicts of Interest: The series “Advanced Techniques in Complex Cervical Spine Surgery” was commissioned by the editorial office without any funding or sponsorship. LAT serves as the unpaid editorial board member of Journal of Spine Surgery from Jan. 2019 to Jan. 2021 and served as the unpaid Guest Editor of the series. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Intraoperative view of the anterior cervical uncinectomy. A Penfield #2 dissector is used to expose the lateral aspect of the uncinate process (A). A high-speed matchstick burr is used to remove the hypertrophic uncinate process while leaving a thin rim of bone laterally to protect the vertebral artery (B). The residual uncinate is carefully fractured medially using a Penfield #2 or upgoing curette (C). After completion of the uncinectomy the exiting nerve root is directly visualized and found to be adequately decompressed (D).
Figure 2
Figure 2
Preoperative and postoperative cervical X-rays demonstrating the results of anterior cervical uncinectomy. Preoperative AP (A) and oblique (B) X-rays demonstrate uncinate hypertrophy at C5–6 (arrowheads) with associated bony foraminal stenosis. Postoperative AP (C) X-rays demonstrate complete uncinectomy (arrowheads) with bilateral foraminal decompression and intact ACDF graft and plate construct (D).
See this image and copyright information in PMC

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