ANTEROLATERAL APPROACH IN MANAGEMENT OF DEGENERATIVE LOWER CERVICAL DISEASE

Abstract

Objective: This study details assessment of the indications, safety, efficacy and complications of an anterolateral approach (a minimally invasive anterolateral foraminotomy approach and an oblique corpectomy approach) for treatment of cervical spondylotic radiculopathy alone or associated with myelopathy. Methods: A prospective study conducted on twenty patients with unilateral cervical spondylotic radiculopathy alone or associated with myelopathy confirmed by clinical and radiological data, refractory to non-surgical measures for at least 6 months. In the period between October 2010 and November 2012, patients were operated upon at Cairo university hospitals and Al-Haram hospital. Outcome of patients with only unilateral radiculopathy (n=14) was categorized according to Odom’s criteria and outcome of patients with unilateral radiculopathy associated with myelopathy (n=6) was graded according to the modified Japanese Orthopaedic Association (mJOA) Scale and the recovery rate was calculated. Results: Average age of presentation was 46.25 years, male to female ratio was 1.86:1 and average duration of symptoms was 12.25 months. 12 cases had right sided radiculopathy, 8 cases had left sided radiculopathy. The most common presenting symptom after brachialgia (100%) was neck pain (85%); most common sign was motor weakness (60%). Most common operated level was C4-5 (40.7%). Excellent and good outcomes of patients with only unilateral radiculopathy were obtained in 92.86% of the patients while patients with unilateral radiculopathy associated with myelopathy were obtained in 83.33% of the patients and the mean recovery rate was 68.5%. The mean follow up period was 17.1 months with no recurrence, instability, progressive kyphosis, vertebral collapse nor other late complications like adjacent segment disease. Conclusion: Microscopic anterolateral cervical foraminotomy seem to be an effective surgical procedure for the treatment of unilateral radiculopathy caused by posterolateral osteophytes or herniated hard disc with comparable results to the conventional anterior cervical discectomy and fusion. The oblique corpectomy technique seem to be an effective surgical procedure for the treatment of unilateral multilevel spondylotic myeloradiculopathy with comparable results to conventional median corpectomy and fusion and multilevel anterior cervical discectomies and fusion techniques Key words: Cervical spine, cervical spondylosis, cervical radiculopathy, cervical myelopathy, anterolateral foraminotomy, oblique corpectomy.