Cervical Spinal Epidural Hematoma Following Cervical Posterior Laminoforaminotomy

A 65-year-old man who had lateral cervical disc herniation underwent cervical posterior laminoforaminotomy at C5-6 and C6-7 level right side. During the operation, there was no serious surgical bleeding event. After operation, he complained persistent right shoulder pain and neck pain. Repeated magnetic resonance image (MRI) showed diffuse cervical epidural hematoma (EDH) extending from C5 to T1 level right side and spinal cord compression at C5-6-7 level. He underwent exploration. There was active bleeding at muscular layer. Muscular active bleeding was controlled and intramuscular hematoma was removed. The patient's symptom was reduced after second operation. Symptomatic postoperative spinal EDH requiring reoperation is rare. Meticulous bleeding control is important before wound closure. In addition, if patient presents persistent or aggravated pain after operation, rapid evaluation using MRI and second look operation is needed as soon as possible.

Cervical Pedicle Screw Insertion Using the Technique with Direct Exposure of the Pedicle by Laminoforaminotomy

OBJECTIVE: To present the accuracy and safety of cervical pedicle screw insertion using the technique with direct exposure of the pedicle by laminoforaminotomy. METHODS: We retrospectively reviewed 12 consecutive patients. A total of 104 subaxial cervical pedicle screws in 12 patients had been inserted. We also assessed the clinical and radiological outcomes and analyzed the direction and grade of pedicle perforation (grade 0: no perforation, 1: 50% of screw diameter) on the postoperative vascular-enhanced computed tomography scans. Grade 2 and 3 were considered as incorrect position. RESULTS: The correct position was found in 95 screws (91.3%); grade 0-75 screws, grade 1-20 screws and the incorrect position in 9 screws (8.7%); grade 2-6 screws, grade 3-3 screws. There was no neurovascular complication related with cervical pedicle screw insertion. CONCLUSION: This technique (technique with direct exposure of the pedicle by laminoforaminotomy) could be considered relatively safe and easy method to insert cervical pedicle screw.

Surgical Results of Posterior Laminoforaminotomy and Discectomy for Cervical Disc Herniation

OBJECTIVE: Whether the anterior approach is better than the posterior one for cervical disc disease still remains unsettled. However, anterior discectomy and fusion procedures for all types of discs have been more popular than the posterior one. Posterior approach should not be underestimated since it has many benefits. To study it's feasibility, the effectivenes and safety of the lamino-foraminotomy for cervical disc disease, we review 10 surgical cases with posterior approach. METHODS: Ten consecutive cervical lateral disc protrusion cases which underwent lamino-foraminotomy with or without discectomy were reviewed. Patient's age, sex, main symptom, EMG studies, surgical procedure were studied retrospectively. The outcome was rated with Prolo's scale. RESULTS: There were one female and nine male patients. Major preoperative symptoms were radicular pain radiating to upper extremity, numbness, axial neck pain and motor weakness. Electromyography was performed in eight cases with six correspondent results. Lamino-foraminotomy was performed in all cases and discectomy was done in nine patients. By modified Prolo's outcome scale, nine patients enjoyed good results and one was moderate, nine patients were able to carry on their original occupations. The mean hospital stay was 14.6 days. There was no postoperative instability. CONCLUSION: With posterior approach, critical complications of anterior approach could be averted. No bone graft is needed. No graft donor site pain is expected either. Hospital stay could be shortened. The posterior foraminotomy is an easy and effective procedure in the treatment of patients for laterally located soft disc herniations.

A Case of Cervical Far Lateral Disc Herniation-Case Report-

Compared to the lumbar region, it is very rare to encounter far lateral disc herniation in the cervical spine, and because of this, correct diagnosis before surgery is difficult: the condition can, however, be identified through the use of advanced MRI imaging techniques. In this case, far lateral disc herniation at C7-T1 was effectivery removed through posterior laminoforaminotomy, and soon after surgery, the patient's symptoms showed complete remission.