Cervical foraminotomy is a popular procedure with surgeons to treat patients
with refractory cervical radicular pain. Traditionally, it has been performed from the
posterior approach. With the advent of minimally invasive spinal surgery techniques
(MISST), anterior methods have also been employed to approach the compressive
pathology from the axilla of the painful cervical nerve root. The authors of this chapter
present their technique of transdiscal endoscopic anterior cervical discectomy
foraminoplasty using an instrument system comprised of serial dilators, trephines,
rongeurs, and a pulsed radiofrequency probe. They demonstrate the steps of the
procedure from patient positioning, placement of surgical access, the employment of
the individual surgical instruments, and their clinical outcomes. The authors briefly
describe their clinical experience over a twenty-one year period. They performed a total
of 232 procedures on 169 patients with single and up to 4 level surgeries herniate disc
(219/232; 94.39%). An additional 13 patients (4.9%) had procedures for the treatment
of lateral cervical canal stenosis. At a one-year follow-up, 90% of patients were rated
to have had Excellent and Good Macnab outcomes, whereas Fair and Poor results were
reported by 7%, and 3% of patients, respectively. In the absence of intraoperative or
postoperative complications or reoperations associated with the procedure, the authors
recommended it as a simplified outpatient alternative to anterior cervical discectomy
and fusion.
Keywords: Anterior approach, Cervical disc herniations, Endoscopic surgery,
Foraminal stenosis, Outpatient, Pulsed radiofrequency, Radicular pain.
