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  • Extreme Lateral Cervical Foraminotomy with an Anterior-Oblique Minimally Invasive approach. Feasibility cadaveric and radiologic study

    Final Number:

    Miguel E Berbeo MD, MSc; Roberto C. Diaz MD; Juan C. Acevedo MD; Oscar Zorro MD; OSCAR HERNANDO FEO - LEE MD; Rafael Uribe MD; Silvia T Quintero; Jaime Becerra; Laura Diaz; Juan C Perez

    Study Design:
    Laboratory Investigation

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Purpose: To analyze the feasibility of a minimally invasive anterior extreme-lateral approach for decompression of the cervical subaxial foramina with the proposal of decrease the upper airways and esophagus manipulation

    Methods: We performed a review of one hundred cervical MRI of a radiological data-base of patients from one university hospital. We described distances, angles, and anatomical relationships of a thirty degrees to the sagittal plane angled approach to the neuroforamina in the cervical spine. After that we performed a cadaveric approach following the radiologically defined surgical way to the cervical foramina for decompression

    Results: There are different anatomical considerations for the superior and inferior cervical levels. The initial planned approach w as medial to the ECM muscle. How ever, at the lower cervical disc spaces this proposal could be difficult to attain because of the medial position of the ECM muscle inferior attachment in the sternum. On average, for the direct approach to the uncinate process the angulation is about 30 degrees (47.3 - 22.1) to the sagittal plane.

    Conclusions: A thirty degrees from midline anterior approach targeted to the anterior transverse tubercle, allowed us to expose directly the uncinate process. The decompression of the neural foramen would be attained by resection of the posterior half of the uncinate process and the piece of disc on the way. We think that this approach is feasible in the clinical setting. We have to adapt now the approach for endoscopic and/or MIS tubular surgical instruments, while considering the inherent risks associated to the manipulation of the neurovascular structures of the zone.

    Patient Care: In patients with cervical foraminal stenosis and preserved cervical lordosis, we could have an MIS option to decompress the root, with a lesser risk to the airways and esophagus compared to anterior cervical decompression and fusion

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the anatomical relationships between the structures involved in the MIS anterolateral approach to the neural foramina in the cervical spine


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