Total Anterior Uncinatectomy During Anterior Discectomy and Fusion for Recurrent Cervical Radiculopathy: A Two-dimensional Operative Video and Technical Report

Abstract

A common cause of cervical radiculopathy from degenerative foraminal stenosis is severe uncovertebral hypertrophy. It is difficult to accomplish complete foraminal decompression in these cases with posterior techniques without the removal of a large portion of the facet joint. Total removal of the uncovertebral joint from an anterior approach allows for complete decompression of the exiting cervical nerve root and has been shown to be a safe technique. In this surgical video and technical report, we demonstrate the surgical anatomy and operative technique of a two-level anterior uncinatectomy during anterior discectomy and fusion (ACDF) for recurrent cervical radiculopathy after a previous multi-level posterior foraminotomy. The patient is a 67-year-old male with a progressive left arm and neck pain with radiographic, clinical, and electrophysiologic diagnostic evidence of active C6 and C7 radiculopathies from degenerative foraminal stenosis at the C5-6 and C6-7 levels. Posterior foraminotomies had been performed without significant improvement in his radicular pain. A repeat MRI demonstrated lateral foraminal stenosis from severe uncovertebral joint hypertrophy at the C5-6 and C6-7 levels. After acquiring informed consent from the patient, an anterior approach was performed with complete removal of the uncovertebral joints at both levels with discectomy and fusion. Postoperatively, the patient had complete resolution of his radicular pain and remained pain-free at the latest follow-up. Complete uncinatectomy and ACDF is an effective technique for complete foraminal decompression in cases of refractory radiculopathy and neck pain after unsuccessful posterior decompression.

Keywords: anatomy; anterior cervical discectomy and fusion; cervical spine; spine surgery; surgical video; uncinate; uncinatectomy; uncinectomy; uncovertebral joint; vertebral artery.

Figure 1. Operative view of the C6-7 disc space and left foramen

After the uncinate is removed, the pedicle can be palpated with an angled instrument ensuring complete decompression of the foramen. The blue arrow indicates the location of the pedicle

Figure 2. Postoperative X-ray after C5-7 ACDF with total uncinatectomies

The image demonstrates good placement of hardware, with lucency in the C5-6 and C6-7 foramen (red circles) demonstrating complete removal of the uncinate and total decompression of the cervical roots ACDF: anterior discectomy and fusion