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JBJS Essent Surg Tech. 2016 Jun 8;6(2):e23. doi: 10.2106/JBJS.ST.16.00012. eCollection 2016 Jun 22.

Minimally Invasive Cervical Foraminotomy.

Author information

1
Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia.
2
Department of Orthopedics, Mount Sinai Medical Center, New York, NY.

Abstract

Introduction:

The minimally invasive posterior cervical foraminotomy, a motion-preserving procedure, is an excellent treatment for patients with unilateral radiculopathy secondary to a laterally located herniated disc or foraminal stenosis.

Indications & Contraindications:

Step 1 Position the Patient Video 1:

Place the patient in a prone position on a Jackson table with 6 posts and with the head resting comfortably on a soft facial pillow, and tape the shoulders down to provide traction to the skin and help with fluoroscopic visualization of the lower cervical levels.

Step 2 Perform the Skin Incision:

Make the skin incision adjacent to the spinous process on the side of the abnormality over the operative level.

Step 3 Use Tubular Dilators to Make a Working Portal:

Use sequential dilators to create a working portal and secure the working tube overlying the lamina-facet junction of the operative level.

Step 4 Perform the Laminoforaminotomy Video 2:

Perform the laminoforaminotomy with the use of a high-speed drill and a Kerrison rongeur to create a working window into the foramen.

Step 5 Perform the Foraminal Decompression Video 3:

Use a nerve hook to superiorly retract the nerve root, and perform a discectomy and decompression.

Step 6 Wound Closure and Postoperative Care:

Obtain hemostasis with electrocautery or hemostatic foam and close the wound with a standard layered closure.

Results:

A systematic review and meta-analysis of studies on open or minimally invasive surgical (MIS) techniques for posterior cervical foraminotomy showed a pooled clinical success rate of 92.7% for the 509 patients managed with the open technique and 94.9% for the 208 patients who had the MIS technique; the difference was not significant (p = 0.418)2.

Pitfalls & Challenges:

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