Anterior approach to disc herniation with modified anterior microforaminotomy at C7-T2: technical note.
ABSTRACT An easy surgical method to reach C7-Th and T1-T2 foraminal disc herniation is described.
To describe a surgical technique that involves an anterior approach to disc herniation with inverted cone-shaped partial minicorpectomy.
Anterior approaches to the cervicothoracic junction are difficult in spinal surgery because the operative area is narrow. The manubrium, the clavicles, and the slope of the vertebral bodies obstruct the view of the surgeon. The vascular and neural structures of the superior mediastinum limit the surgical approach. The thoracic duct and recurrent laryngeal nerve present risks for injury, especially with approaches from the right side. Disc herniations at the C7-T2 level are very rare. Posterior approaches at these levels are advocated because radicular symptoms occur more often than myelopathic symptoms, but anterior discectomy and fusion are generally preferred by many spinal surgeons, as these are approaches that are more intuitive.
We review the case histories of all of our patients that underwent inverted cone-shaped partial minicorpectomy and fusion at the C7-T2 disc levels between 2000 and 2008. We applied the surgical techniques described in this manuscript.
The mean follow-up duration was 50 months postoperation. Physical examinations were performed and radiographs were taken at the end of the first 6 months postoperative and every 12 months thereafter. No meaningful changes were recorded on either the Visual Analog Scale or the Neck Disability Index. Cervical alignment was unchanged before and after surgery.
Minicorpectomy technique of C7 or T1 vertebra is an easy and appropriate method for treating foraminal disc herniation between the C7-T1 and T1-T2 levels.
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ABSTRACT: Upper thoracic vertebral bodies are difficult to access using standard anterior approaches. It may require sternotomy and claviculectomy, which carries significant possibility of morbidities. We report a case of inferiorly migrated cervicothoracic junction disc treated successfully by anterior upper-vertebral transcorporeal approach. This specific technique obviated the need of sternotomy, created favorable working space and saved the motion segment at cervicothoracic junction. This report is the first transcorporeal approach to a disc fragment at T1-2 space without fusion.Journal of Korean Neurosurgical Society 01/2011; 49(1):61-4. · 0.60 Impact Factor
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ABSTRACT: Various surgical procedures have been used to repair disc herniations and osteophytes at the cervicothoracic junction. Among these procedures, transvertebral anterior foraminotomy without fusion is a relatively less invasive, safe and useful method, although the majority of spinal surgeons remain unfamiliar with this method. We describe the surgical procedure for a transvertebral anterior keyhole foraminotomy without fusion at the cervicothoracic junction, and we assess the middle-term clinical and radiological outcomes. Of 118 patients undergoing this surgery in our institute between 2007 and 2010, five (4.2 %) had C8 radiculopathy causing C7/T1 disc herniations or osteophytes. We studied five patients who underwent trans-C7 vertebral keyhole foraminotomy without fusion. We retrospectively examined clinical data, pre- and postoperative neurological status. In all cases, surgical decompression was successfully achieved without difficulty when accessing the pathology. No complications related to the surgical procedure were reported. The follow-up period was 12-28 (mean 20) months. In all patients, the visual analogue scale (VAS) due to radicular pain immediately decreased after the operation and did not increase thereafter. The mean VAS decreased from 7.8 (4.5-9.6) to 1.0 (0-2.1). The Cobb angle at C2-T1 in a neutral position improved from -12.6 (-2.8 to -24.7) degrees to -6.9 (4.2 to -25.4). The postoperative C7/T1 disc height decreased from 5.4 to 4.9 mm, indicating minimal loss. This procedure allows for direct access to the pathology and is less invasive. In this study, we clarified that this technique yields excellent radiological and clinical outcomes.Acta Neurochirurgica 09/2012; 154(10):1797-802. · 1.79 Impact Factor