Anterior Cervical Microforaminotomy

Cervical radiculopathy is typically caused by posterolateral disc herniation or spondylotic foraminal stenosis. Standard surgical treatment for cervical degenerative disc disease has been either direct anterior excision necessitating fusion or indirect posterior decompression. Anterior decompression has now become more widely used. It can be achieved using different techniques. Anterior fusion procedures; Anterior cervical discectomy with fusion is an excellent option for one or two-level spondylosis. Anterior corpectomy may provide an improved decompression and is ideal for patients with kyphotic deformity (1). Anterior cervical discectomy with fusion and corpectomy techniques requires bone fusion with or without spinal instrumentation, and a degenerative change at adjacent vertebral levels frequently results in long-term morbidity. Wada et al. (1) demonstrated that listhesis exceeding 2 mm developed at 38% of the upper adjacent levels, osteophyte formation occurred at 54% of the lower adjacent levels, and axial pain was observed in 15%. The mean vertebral range of motion had decreased from 39.4 degrees to 19.2 degrees in 49% of patients by the final follow-up assessment. In addition, conventional corpectomy series are excessively focused on greft morbidity and pseudoarthrosis (1-3). Anterior cervical foraminotomi (ACF); The ACF technique involves direct decompression of the nerve root just as the anterior discectomy techniques does, but does not require bone fusion or postoperative immobilization. In addition, ACF preserves the motion unit anatomically as well as functionally. The drilling is much more extended laterally on the operative side, and ACF totally opens the intervertebral foramen. ACF requires considerable technical skill to keep the intervertebral disc intact functionally. To maintain spinal stability, ACF hole has to be small enough to maintain structural integrity. Extensive decompression can easily cause symptoms of spinal instability even flexion-extension radiographs reveal no obvious instability postoperatively. Jho (4, 5) showed that excellent clinical outcomes with fast recovery and adequate anatomical decompression in patients with cervical spondylotic myelopathy and radiculopathy. Johnson et al. (6) reported the good or excellent outcomes in 85% of patients treated with ACF. However, Hacker and Miller (5) retrospectively reviewed 23 patients who underwent ACF, and they found that 30% of patients’ required additional surgery and 53% of patients experienced a good or excellent outcome. Reoperation rate is considerably higher than other series of anterior cervical surgery for radiculopathy. Their poor surgery-related outcome seems to be directly due to spinal instability and collapse of the neural foramen caused by their excessive removal of the uncinate process. Katoni et al. (8) showed that uncovertebral joint resection resulted in decreased stability of the functional spine unit in every plane of motion.