Anterior cervical foraminotomy and fusion. Surgical technique and results.

STUDY DESIGN: This study retrospectively reviewed the clinical and radiographic results of a series of patients who underwent osteophyte resection during anterior discectomy and fusion. OBJECTIVE: To determine whether resection of the posterior uncinate process at the time of anterior cervical discectomy is safe and effective. SUMMARY OF BACKGROUND DATA: Previous studies have described techniques of osteophyte resection, but safety and outcome have not been supported by a clinical series of patients. METHODS: Forty-three consecutive patients with radiculopathy due to spondylosis or lateral herniated nucleus pulposus had 68 foraminotomies done at the time of anterior cervical disc foraminotomy for radiculopathy. All patients were followed-up until radiographic union. All patients were examined, and Odom's criteria were used to assess postoperative pain and function in the neck, arm, and iliac donor site. RESULTS: The results were consistent with previous reports of anterior cervical disc foraminotomy for radiculopathy. Excellent and good results occurred in 77% and 14% of the patients, respectively. Three patients had no relief and no patient had worsening of radiculopathy. The fusion rate was 93%. Thirty-one patients (72%) reported being very satisfied. Three patients required a re-operation--one for bone graft dislodgment and two for pseudoarthrosis. No vascular injuries occurred. CONCLUSIONS: Resection of the posterior portion of the uncinate process to remove osteophytes that narrow the neural foraman or to allow direct visualization of laterally herniated disc material can be done safely. When combined with an autogenous interbody bone graft, good results can be expected.

Lumbar epidural varix as a cause of radiculopathy.

STUDY DESIGN: Venous outflow obstruction or congestion has been implicated in the etiology of some lumbar radicular syndromes. Ten cases of epidural varices or variants manifesting themselves as masses within the lumbar spinal canal or adjacent foramina have been seen. OBJECTIVES: Diagnosis was made by multiplanar cross-sectional magnetic resonance and computed tomography imaging and confirmed in five patients by operative findings. These venous abnormalities differ from cases of arteriovenous malformations described in the literature. METHOD: Surgical treatment consisting of coagulative oblation and/or excision of the lesion was consistently successful in the five patients who underwent operations for recalcitrant symptoms. The other five patients experienced spontaneous resolution of symptoms. Three distinctly different types of these abnormalities have been identified. RESULTS: The described entity may account for some previously unexplained or spontaneously resolving cases of lumbar radiculitis. CONCLUSIONS: Knowledge of the existence of this condition, its possible etiologies, and its imaging characteristics may assist in its recognition and improved management of patients with it.