Elsevier

The Spine Journal

Volume 21, Issue 6, June 2021, Pages 915-923
The Spine Journal

Clinical Study
Long-term clinical and radiological outcomes of anterior uncoforaminotomy for unilateral single-level cervical radiculopathy: retrospective cohort study

https://doi.org/10.1016/j.spinee.2021.01.024Get rights and content

Abstract

BACKGROUND CONTEXT

Anterior cervical discectomy and fusion is a common procedure for degenerative cervical radiculopathy. In 1996, Dr. H.D. Jho reported an operative technique allowing nerve root decompression via anterior uncoforaminotomy whereas avoiding fusion.

PURPOSE

To assess long-term clinical and radiological outcomes of anterior uncoforaminotomy in patients with degenerative cervical spine pathology.

STUDY DESIGN

A single clinic, retrospective cohort study.

PATIENT SAMPLE

Adult patients who underwent anterior uncoforaminotomy from 2013 to 2018.

OUTCOME MEASURES

Clinical outcomes were assessed using VAS, NDI, SF-36 criteria. Radiological parameters included sagittal balance, disc height and White anPanjabi criterion.

MATERIALS AND METHODS

All patients underwent unilateral single-level anterior uncoforaminotomy, and long-term clinical and radiologic follow up was carried out. Clinical outcomes were assessed using VAS, NDI, SF-36 criteria. Radiological parameters evaluated included sagittal balance, disc height and White and Panjabi criteria (3.5 mm of translation, 11 degrees of kyphosis). The mean follow-up period was 33.3 ± 10.6 months (range 12–57 months).

RESULTS

All measures of clinical outcome improved. VAS (neck) and VAS (arm) decreased 3 [2; 4] and 5 [3; 5.2] points (median [interquartile range]), respectively (p<0.001); NDI improved from 0.38 [0.36; 0.4], to 0.29 [0.22; 0.34] (p<0.001). Two patients (6%) required additional surgery one year after operation. There were no complications in the perioperative period. Disc height decreased 0.8 mm [0.1; 2.1] (p<0.001). All patients retained stability of the cervical spine based on White and Panjabi criteria. Sagittal balance parameters did not change significantly.

CONCLUSION

Uncoforaminotomy is an effective and safe method to decompress a unilateral single-level nerve root in degenerative cervical radiculopathy whereas preserving anatomy and motion of the cervical spine.

Introduction

Cervical radiculopathy is a common complaint with an incidence of 107/100,000 (men) and 64/100,000 (women) [1]. Cervical radiculopathy peaks in the sixth decade and risk factors include white race, woman gender, cigarette smoking, axial load bearing, and before lumbar radiculopathy [2,3]. The clinical manifestation of cervical radiculopathy includes neck pain that radiates to the upper limbs with impaired movement of the upper limbs in 68%, scapular pain in 53%, paresthesia in 46%, chest pain in 18% and headache in 10% [4]. The cervical root syndrome was first described by Semmes and Murphey in 1954 [5]. The first report of cervical herniated disc successfully treated surgically (by laminectomy) was published in 1934 by Mixter and Barr [6]. Today, there are several routinely used surgical methods for this condition: anterior cervical discectomy with or without fusion, anterior cervical disc replacement, anterior uncoforaminotomy, and posterior foraminotomy. Here we report our experience using anterior uncoforaminotomy described by Jho in 1996 [7]. We prefer this approach for unilateral single-level cervical radiculopathy as it provides adequate decompression of the nerve root whereas preserving stability and functional mobility of the affected segment.

Section snippets

Clinical material

This study was approved by the ethics committee and given the retrospective cohort design and lack of any patient identification parameters, did not require patient consent. Over the course of five years (2013–2018), 73 patients underwent anterior uncoforaminotomy by the method of Jho for single level unilateral cervical radiculopathy. Inclusion criteria were as follows: (1) unilateral cervical radiculopathy unresponsive to conservative treatment of more than 6 weeks (or 4 weeks in patients

Demographic data

73 patients underwent anterior uncoforaminotomy by the method of Jho. Only thirty-six patients met inclusion criteria and were enrolled in this study. There were 16 (44%) men and 20 (56%) women, and the mean age was 42 ± 7.8 years (Table 2). All patients were diagnosed foraminal narrowing causing nerve compression from degeneration of the cervical spine with single segment involvemen. Diagnosis was confirmed by the combination of clinical cervical radiculopathy and radiological evidence of

Discussion

The first successful surgical intervention for the syndrome of cervical radiculopathy was described by Mixter et al in 1934 using laminoplasty [6]. Because then, a number of operative techniques have been developed to treat this condition. These developments began with posterior approaches, providing indirect decompression of the spinal nerve roots but did not provide direct decompression of the pathologic source. The desire to more directly treat the compressive pathology led to the

Conclusion

The article presents our clinical experience using anterior unсforaminotomy in patients with single-level cervical radiculopathy. In our series of 36 patients evaluated long-term, evaluated both clinically and radiographically, we can conclude that uncoforaminotomy is an effective and safe method that produces a favorable clinical outcome, whereas preserving the anatomy of the cervical spine. The lack of surgical implant (artificial disc or plate fixation) reduces the cost of the procedure and

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    Author disclosures: VSK: Nothing to disclose. VVK: Nothing to disclose. BLC: Nothing to disclose. AVE: Nothing to disclose. EAL: Nothing to disclose. EVA: Nothing to disclose. AVB: Nothing to disclose. APP: Nothing to disclose. JAR: Nothing to disclose.

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