The condition of anomalous nerve root is rare. The authors are reporting a case of conjoined nerve root anomaly associated with lumbar disc herniation in a 36-year-old male who was transferred from another hospital. A standard hemilaminectomy with a discectomy had been performed under the disgnosis of the L4-5 lumbar disc herniation at the other hospital. However symptoms were not relieved. During a second surgery at our hospital, a L5-S1 conjoined nerve root was discovered after removal of the extradural hematoma at the previous laminectomy site, a medial facetctomy with a foraminotomy were carried out and the conjoined root was decompressed completely. The patient returned to work 2 months postoperatively with complete relief of symptoms.
Adult ; Diskectomy ; Foraminotomy ; Hematoma ; Humans ; Laminectomy ; Male

Lumbar microdiscectomy (MD) is the gold standard for treatment of lumbar disc herniation. Generally, the surgeon attempts to protect the facet joint in hopes of avoiding postoperative pain/instability and secondary degenerative arthropathy. We believe that preserving the facet joint is especially important in young patients, owing to their life expectancy and activity. However, preserving the facet joint is not easy during lumbar MD. We propose several technical tips (superolateral extension of conventional laminotomy, oblique drilling for laminotomy, and additional foraminotomy) for facet joint preservation during lumbar MD.
Foraminotomy ; Humans ; Laminectomy ; Life Expectancy ; Zygapophyseal Joint*

OBJECTIVE: Although minimally invasive posterior cervical foraminotomy (MI-PCF) is an established approach for motion preservation, the outcomes are variable among patients. The objective of this study was to identify significant factors that influence motion preservation after MI-PCF. METHODS: Forty-eight patients who had undergone MI-PCF between 2004 and 2012 on a total of 70 levels were studied. Cervical parameters measured using plain radiography included C2–7 plumb line, C2–7 Cobb angle, T1 slope, thoracic outlet angle, neck tilt, and disc height before and 24 months after surgery. The ratios of the remaining facet joints after MI-PCF were calculated postoperatively using computed tomography. Changes in the distance between interspinous processes (DISP) and the segmental angle (SA) before and after surgery were also measured. We determined successful motion preservation with changes in DISP of ≤3 mm and in SA of ≤2°. RESULTS: The differences in preoperative and postoperative DISP and SA after MI-PCF were 0.03±3.95 mm and 0.34±4.46°, respectively, fulfilling the criteria for successful motion preservation. However, the appropriate level of motion preservation is achieved in cases in which changes in preoperative and postoperative DISP and SA motions are 55.7 and 57.1%, respectively. Based on preoperative and postoperative DISP, patients were divided into three groups, and the characteristics of each group were compared. Among these, the only statistically significant factor in motion preservation was preoperative disc height (Pearson’s correlation coefficient=0.658, p<0.001). The optimal disc height for motion preservation in regard to DISP ranges from 4.18 to 7.08 mm. CONCLUSION: MI-PCF is a widely accepted approach for motion preservation, although desirable radiographic outcomes were only achieved in approximately half of the patients who had undergone the procedure. Since disc height appears to be a significant factor in motion preservation, surgeons should consider disc height before performing MI-PCF.
Foraminotomy* ; Humans ; Neck ; Radiography ; Surgeons ; Zygapophyseal Joint

A combined anterior and lateral approach to the anterior cervical canal was performed on 2 patients with cervical dumbbell-shaped tumors. The procedure consists of anterior discetomy and ispsilateral uncectomy, and removal of the posterolateral corners and posterior transverse fidges of the upper and lower verterbral bodies at the tumor. In one case of a large tumor in the spinal canal, additional removal of a limited segment from the lateral part of the vertebral body was performed and the bone defect was filled with a T-shaped bone graft. The higest level of the operation was C-2 and the lowes was C-4. The authors believe that any cervical dumbbell-shaped tumor below the C-2 level can be removed via anterolateral approach as long as no more than 3 levels of the spine are involved.
Foraminotomy ; Humans ; Spinal Canal* ; Spine ; Transplants

OBJECTIVE: To evaluate the effectiveness of posterior microforaminotomy in treatment of posterolateral cervical disc herniation, the authors retrospectively analyzed the result of posterior microforaminotomy in our institute. PATIENTS AND METHODS: Ten patients with radiculopathy due to posterolateral cervical disc herniation have been treated with posterior microforaminotomy from August 1996 to July 2000. We analyzed clinical results in all patients who were followed up for an average of 10 months. RESULTS: The mean age was 47.2 years and all patients were treated with posterior microforaminotomy as primary treatment. one patient was received anterior cervical interbody fusion with iliac bone 12 years before. Clinical improvement in the last follow-up were seen in all patients and there were no complications. CONCLUSION: Microcervical foraminotomy is considered useful operative method for posterolateral soft disc herniation. We conclude that the posterior microforaminotomy for radiculopathy due to soft posterolateral cervical disc herniation seems to be safe and effective in selective patients.
Follow-Up Studies ; Foraminotomy ; Humans ; Radiculopathy ; Retrospective Studies

A case of total spondyloptosis of the cervical spine at C6-7 level with cord compression is described in a 51-year-old male. Because the bodies of C6 and 7 were tightly locked together, cervical traction failed. Then the patient was operated on by a posterior approach. Posterior stabilization and fusion were performed by C4-5 lateral mass and C7-T1 pedicle screw fixation and rod instrumentation with bridging both C4-5's rods to the C7-T1's extended ones. After C6 total laminectomy and foraminotomy, the C6 body was returned to its proper position. Secondly, anterior stabilization and fusion were performed by C6-7 discectomy with a screw-plate system. A postoperative lateral plain radiograph showed good realignment. In this case, we report the clinical presentation and discuss the surgical modalities of C6-7 total spondyloptosis and the failed close reduction.
Diskectomy ; Foraminotomy ; Humans ; Laminectomy ; Male ; Middle Aged ; Spine ; Traction

OBJECTIVE: The authors present the clinical and radiologic outcomes of microsurgical anterior foraminotomy in 36 cases of cervival radiculopathy. METHODS: Thirty-six patients were treated with anterior cervical foraminotomy between January 1998 and June 2002. There were 13 men and 23 women(age range, 34-74 years). Twenty-nine had symptomatic soft disc herniation and 7 had uncovertebral osteophytes confirmed by magnetic resonance imaging and computed tomography. Thirty-one patients had single anterior cervical microforaminotomy and five had procedures at adjacent levels. RESULTS: Good or excellent result were obtained in 75% of the patients. On roentgenographic examination, the height of intervertebral space was maintained at twenty-one levels(51%) and was decreased at seventeen levels(42%). Two patients who underwent anterior cervical microforaminotomy developed kyphosis of the cervical spine and one patient developed instability of the cervical spine. CONCLUSION: Anterior cervical foraminotomy appears to be a good alternative procedure for carefully selected patients with unilateral cervical radiculopathy and avoids a fusion of the disc space.
Foraminotomy* ; Humans ; Kyphosis ; Magnetic Resonance Imaging ; Male ; Osteophyte ; Radiculopathy* ; Spine

The technique we describe was developed for cervical foraminal stenosis for cases in which a keyhole foraminotomy would not be effective. Many cervical stenosis cases are so severe that keyhole foraminotomy is not successful. However, the technique outlined in this study provides adequate enlargement of an entire cervical foraminal diameter. This study reports on a novel foraminal expansion technique. Linear drilling was performed in the middle of the facet joint. A small bone graft was placed between the divided lateral masses after distraction. A lateral mass stabilization was performed with screws and rods following the expansion procedure. A cervical foramen was linearly drilled medially to laterally, then expanded with small bone grafts, and a lateral mass instrumentation was added with surgery. The patient was well after the surgery. The novel foraminal expansion is an effective surgical method for severe foraminal stenosis.
Constriction, Pathologic ; Foraminotomy ; Humans ; Methods ; Transplants ; Zygapophyseal Joint

OBJECTIVE: The purpose of this study is to elucidate the anatomic relationships between the uncinate process and surrounding neurovascular structures to prevent possible complications in anterior cervical surgery. METHODS: Twenty-eight formalin-fixed cervical spines were removed from adult cadavers and were studied. The authors investigated the morphometric relationships between the uncinate process, vertebral artery and adjacent nerve roots. RESULTS: The height of the uncinate process was 5.6-7.5 mm and the width was 5.8-8.0 mm. The angle between the posterior tip of the uncinate process and vertebral artery was 32.2-42.4degrees. The distance from the upper tip of the uncinate process to the vertebral body immediately above was 2.1-3.3 mm, and this distance was narrowest at the fifth cervical vertebrae. The distance from the posterior tip of the uncinate process to the nerve root was 1.3-2.0 mm. The distance from the uncinate process to the vertebral artery was measured at three different points of the uncinate process : upper-posterior tip, lateral wall and the most antero-medial point of the uncinate process, and the distances were 3.6-6.1 mm, 1.7-2.8 mm, and 4.2-5.7 mm, respectively. The distance from the uncinate process tip to the vertebral artery and the angle between the uncinate process tip and vertebral artery were significantly different between the right and left side. CONCLUSION: These data provide guidelines for anterior cervical surgery, and will aid in reducing neurovascular injury during anterior cervical surgery, especially in anterior microforaminotomy.
Adult ; Cadaver ; Cervical Vertebrae ; Female ; Foraminotomy ; Humans ; Spine ; Vertebral Artery

OBJECTIVE: This study was undertaken to evaluate the feasibility of minimally invasive posterior surgical approach for cervical disc diseases. METHODS: The authors performed cervical key hole foraminotomies using the microendoscopic discectomy (MED) system in four cadaveric cervical spine specimens. Three non-contiguous cervical nerve roots were selected between C3 and C8 in each specimen and were decompressed using MED system on one side. Contralateral sides were decompressed using the open foraminotomy procedure. The amount of bony decompression achieved with the MED system was compared to that achieved with the open foraminotomy procedure in each cadaveric specimen. RESULTS: Postop CT-myelogram and postoperative open dissection showed adequate bony decompression was achieved with either the MED or open procedure in all specimens. The laminotomy size(vertical and transverse diameter), the length of decompressed nerve root, and the proportion of removed facet joint were measured on every operated level. The average vertical diameter of laminotomy area and the percentage of facet removed were significantly greater in the MED procedure than the open procedure(p<0.05). The transverse diameter of the laminotomy area and the average decompressed root length were not significantly different between MED and open surgery. CONCLUSION: We conclude endoscopic cervical foraminotomy using the MED system is a feasible procedure and may be applicable to the treatment of foraminal stenosis and laterally located cervical disc herniation in clinical settings.
Cadaver ; Constriction, Pathologic ; Decompression ; Diskectomy ; Foraminotomy* ; Laminectomy ; Spine ; Zygapophyseal Joint