Anterior Cervical Foraminotomy for Radiculopathy

Frank D. Vrionis, MD, PhD
Jeffrey M. Sorenson, MD (Memphis, TN)

The anterior cervical foraminotomy has recently been introduced as a minimally invasive approach for decompression of nerve roots or the spinal cord. Ten patients underwent anterior cervical foraminotomy at C5–6 (2/10) or C6–7 (8/10) for radiculopathy. All patients had failed to improve with conservative measures. Patients with chronic neck pain prior to the onset of radiculopathy were not included.

In two cases, an aberrant course of the vertebral artery was noted.

There were no vertebral artery injuries or operative complications. A soft centro–lateral or lateral disc herniation was found between the two layers of the posterior longitudinal ligament in seven cases. Osteophytes were encountered and easily addressed in three cases. Clinical follow–up averaged three months. All patients had resolution of radicular pain and returned to their previous level of activity. Other radicular symptoms also resolved or were significantly improved. There was no cervical instability following the operation. Compared to a group of 23 patients who underwent an anterior cervical discectomy and fusion for radiculopathy by the same surgeon, patients who underwent anterior cervical foraminotomy had similar outcomes with respect to radicular symptoms. We believe that anterior cervical foraminotomy is a safe and effective alternative to anterior cervical discectomy and fusion, or posterior cervical discectomy for patients with radiculopathy related to a herniated disc or osteophyte. In this group of patients, the outcome was similar, but the cost was less, and the motion segment was preserved. Long term followup is needed to further substantiate these conclusions.