Modified cervical laminoforaminotomy based on anatomic landmarks reduces need for bony removal

E. Gadelha Figueiredo, M. Castillo De La Cruz, N. Theodore, P. Deshmukh, Mark C. Preul

Research output: Contribution to journalArticlepeer-review

Abstract

We describe a modified keyhole laminoforaminotomy (LF) using anatomic landmarks on the posterior aspect of the cervical vertebral body to decompress the intervertebral foramen with minimal bone removal. Twenty-four procedures were performed at C3-4, C4-5, and C5-6; 12 at C6-7; and 3 at C7-T1. Facets and laminae structures were identified based on relative surgical perspectives. Bony resection was limited as follows: 1) inferior limit; inferior border of the superior facet; 2) superior limit, superior border of the superior facet; 3) lateral limit, a vertical line linking the junction of the lamina-facet to the lateral end of the superior limit; and 4) lateral aspect of the dural sac. Fluoroscopy was used to confirm that the intervertebral space was reached. The amount of bony removal was quantified for the superior and inferior laminae and facets. The length of the exposed nerve root was measured. The intervertebral foramen was exposed and the intervertebral disc reached in all specimens. Fluoroscopy showed that the center of the exposure remained at the same height with the intervertebral space. The mean length of the nerve root was 4.6 mm; the mean percentage of bony resection was 21.8%, 7.5%, 11.3%, and 11.5% for the superior and inferior laminae and facets, respectively. Opening the intervertebral foramen posteriorly consistently exposed sufficient nerve root length and allowed access to the intervertebral disc. The technique offers the most direct and safest method of decompressing the intervertebral foramen while minimizing bony resection. This simple surgical procedure may help reduce postoperative morbidity.

Original languageEnglish (US)
Pages (from-to)37-42
Number of pages6
JournalMinimally Invasive Neurosurgery
Volume49
Issue number1
DOIs
StatePublished - Feb 1 2006
Externally publishedYes

Keywords

  • Cervical laminoforaminotomy
  • Cervical pedicle
  • Facet joint
  • Surgical technique

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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