Introduction: Symptomatic cervical foraminal stenosis caused by hypertrophy of the uncovertebral and facet joints is often accompanied by central canal stenosis. Posterior cervical foraminotomy does not allow resection of the centrally-located disc-osteophyte complex. Anterior cervical foraminotomy during anterior discectomy is often limited to resection of the medial aspect of the uncinate process for fear of injury to the nearby vertebral artery and may not sufficiently decompress the neural foramen. An ultrasonic bone dissector (BoneScalpel) with a non-rotating tip can be used to safely approach the vertebral artery. A novel method for total resection of the uncinate process to completely unroof the neural foramen and expose the vertebral artery is presented.
Methods: 22 patients with severe symptomatic osseous foraminal stenosis in addition to central disc herniations and spondylosis underwent anterior cervical discectomy and fusion accompanied by complete uncinectomy. An ultrasonic bone dissector equipped with a micro-shaver tip was used to cut the base of the uncinate process from a medial to lateral orientation until the vertebral artery canal was reached. The residual uncinate process was then disarticulated from the uncovertebral joint and elevated away from the vertebral artery and the nerve root.
Results: In all cases it was possible to easily remove the uncinate process as planned. No injury to the vertebral artery occurred in any of the cases. Good relief of cervical radicular symptoms was achieved in all cases. Post-operative computed tomography and oblique radiographs confirmed complete decompression of the neural foramen. Clinical and radiographic outcome data and a step-by-step description of the procedure using surgical videos and diagrams are presented.
Conclusions: Complete resection of the uncinate process can be achieved in a safe and expeditious manner using an ultrasonic bone dissector, thus providing better decompression of the nerve root via an anterior approach.
Patient Care: It will enhance the efficacy and safety of anterior cervical foraminotomy.
Learning Objectives: By the conclusion of this presentation, participants should be able to: 1) Identify the limitations of existing anterior and posterior approaches for decompression of the cervical nerve root, 2) Discuss the safety features of ultrasonic bone dissection compared to drills and manual instruments, and 3) Describe the steps for successful resection of the uncinate process using an ultrasonic bone dissector.