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Hae-dong Jho - One of the best experts on this subject based on the ideXlab platform.
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Decompression via microsurgical anterior Foraminotomy for cervical spondylotic myelopathy. Technical note.
Journal of neurosurgery, 1997Co-Authors: Hae-dong JhoAbstract:✓ Over the past few years, a microsurgical anterior Foraminotomy technique has been developed by the author and used to achieve spinal cord decompression for the treatment of cervical spondylotic myelopathy. A 5 × 8—mm unilateral anterior Foraminotomy is accomplished by resecting the uncovertebral joint via an anterior approach. Through the Foraminotomy hole, the posterior osteophytes at the spinal cord canal are removed diagonally up to the beginning of the contralateral nerve root. To treat multilevel disease, a tunnel is made among the Foraminotomy holes. This technique accomplishes widening of the spinal cord canal in the transverse and longitudinal axes by direct resection of the compressive lesions through the holes of unilateral anterior foraminotomies; however, it does not require bone fusion or postoperative immobilization. Postoperatively patients remain in the hospital overnight, and do not need to wear cervical braces. This new surgical technique has shown excellent clinical outcomes with fast...
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Decompression via microsurgical anterior Foraminotomy for cervical spondylotic myelopathy: Technical note
Neurosurgical Focus, 1996Co-Authors: Hae-dong JhoAbstract:Over the past few years, a microsurgical anterior Foraminotomy technique has been developed by the author and used to achieve spinal cord decompression for the treatment of cervical spondylotic myelopathy. A 5 X 8-mm unilateral anterior Foraminotomy is accomplished by resecting the uncovertebral joint via an anterior approach. Through the Foraminotomy hole, the posterior osteophytes at the spinal cord canal are removed diagonally up to the beginning of the contralateral nerve root. To treat multilevel disease, a tunnel is made among the Foraminotomy holes. This technique accomplishes widening of the spinal cord canal in the transverse and longitudinal axes by direct resection of the compressive lesions through the holes of unilateral anterior foraminotomies; however, it does not require bone fusion or postoperative immobilization. Postoperatively patients remain in the hospital overnight, and do not need to wear cervical braces. This new surgical technique has shown excellent clinical outcomes with fast recovery and adequate anatomical decompression in patients with cervical spondylotic myelopathy. The surgical technique is reported and illustrated by two of the author's cases.
Dimitriy Kondrashov - One of the best experts on this subject based on the ideXlab platform.
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Anterior Lumbar Interbody Fusion May Provide Superior Decompression of the Foraminal Space Compared with Direct Foraminotomy: Biomechanical Cadaveric Study.
World neurosurgery, 2019Co-Authors: Khalid Odeh, Jeremi M Leasure, Alexander Rosinski, Jacqueline Nguyen, Ashin Modak, Scott Siebert, Dimitriy KondrashovAbstract:Objective The objective of this cadaveric biomechanical study was to compare the area of the foraminal space during motion in the intact condition, after direct decompression via Foraminotomy, and after indirect decompression via anterior lumbar interbody spacer insertion. Methods Eight (8) L5-S1 cadaver specimens were used for testing. Each specimen was tested in the intact state, after posterior Foraminotomy, and after standalone anterior lumbar interbody fusion (ALIF). Each specimen was 3-dimensional imaged under neutral loading, flexion, and extension. The 3-dimensional images were analyzed for changes in the foraminal area under each loading scenario. A repeat-measures design was used. Outcome measures from testing included the frequency in which an increase in cross-sectional area was observed, as well as the percent increase of the foraminal area for each surgical group and loading direction. Results Direct Foraminotomy and ALIF maintained the foraminal space during initial distraction under no loading with areas 99.7% and 96.5% of the native foraminal area, respectively (P = 0.955 and P = 0.455). Direct Foraminotomy increased the foraminal area significantly during flexion to 112.2% of the area before motion (P = 0.008) while ALIF did not. Direct Foraminotomy significantly decreased the foraminal area during extension to 89.2% of the area before motion (P = 0.006). ALIF, however, maintained its initial distraction during extension with 98.2% of the area before motion (P = 0.808). Conclusions ALIF maintains the foraminal area in extension while direct posterior Foraminotomy does not.
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Changes in foraminal area with anterior decompression versus keyhole Foraminotomy in the cervical spine: a biomechanical investigation.
Journal of neurosurgery. Spine, 2017Co-Authors: Jacqueline Nguyen, Bryant Chu, Calvin C Kuo, Jeremi M Leasure, Christopher P Ames, Dimitriy KondrashovAbstract:OBJECTIVEAnterior cervical discectomy and fusion (ACDF) with or without partial uncovertebral joint resection (UVR) and posterior keyhole Foraminotomy are established operative procedures to treat cervical disc degeneration and radiculopathy. Studies have demonstrated reliable results with each procedure, but none have compared the change in neuroforaminal area between indirect and direct decompression techniques. The purpose of this study was to determine which cervical decompression method most consistently increases neuroforaminal area and how that area is affected by neck position.METHODSEight human cervical functional spinal units (4 each of C5–6 and C6–7) underwent sequential decompression. Each level received the following surgical treatment: bilateral Foraminotomy, ACDF, ACDF + partial UVR, and Foraminotomy + ACDF. Multidirectional pure moment flexibility testing combined with 3D C-arm imaging was performed after each procedure to measure the minimum cross-sectional area of each foramen in 3 diffe...
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changes in foraminal geometry with anterior decompression versus keyhole Foraminotomy in the cervical spine a biomechanical investigation
Volume 1A: Abdominal Aortic Aneurysms; Active and Reactive Soft Matter; Atherosclerosis; BioFluid Mechanics; Education; Biotransport Phenomena; Bone J, 2013Co-Authors: Bryant Chu, Calvin C Kuo, Jackie Nguyen, Jeremi M Leasure, Christopher P Ames, Dimitriy KondrashovAbstract:Cervical spondylosis can be treated with various surgical decompression techniques, notably anterior cervical decompression and fusion (ACDF) and posterior keyhole Foraminotomy1. Although each procedure has distinct methods, there is no compelling evidence in the literature to advocate one over the other. Furthermore, subtle differences within the techniques have yet to be examined such as the salvage or resection of uncovertebral joints during ACDF. Systematic reviews2,5 and meta-analyses3 have not elucidated significant differences in pain improvement between ACDF techniques, and no study has compared clinical outcomes for ACDF versus posterior Foraminotomy, the two most popular cervical decompression techniques to date. We provide benchtop evidence as to the relative effectiveness of Foraminotomy, ACDF with or without resection, and a combination of all surgeries. We hypothesized that ACDF with uncovertebral resection would be most effective to open the neuroforamina. Results of this study inform best practices for cervical decompression surgeries.Copyright © 2013 by ASME
Takashi Kaito - One of the best experts on this subject based on the ideXlab platform.
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Direct involvement of concomitant Foraminotomy for radiculomyelopathy in postoperative upper limb palsy in cervical laminoplasty.
World neurosurgery, 2020Co-Authors: Hiroyuki Ishiguro, Shota Takenaka, Masafumi Kashii, Yuichiro Ukon, Yukitaka Nagamoto, Masayuki Furuya, Takahiro Makino, Yusuke Sakai, Takashi KaitoAbstract:Objective Although concomitant Foraminotomy has been reported to increase the risk of postoperative upper limb palsy (ULP) in cervical laminoplasty, the specific effects of concomitant Foraminotomy on ULP remain uncertain. This study aimed to clarify the effect of concomitant Foraminotomy on ULP in cervical laminoplasty. Methods We identified 19 patients who developed ULP after laminoplasty with concomitant Foraminotomy for radiculomyelopathy with nerve root impingement (laminoplasty with concomitant Foraminotomy group [F-group]) from 4080 patients who underwent primary cervical laminoplasty at 27 affiliated institutions between 2012 and 2018. An age- and sex-matched control group comprised patients who developed ULP after laminoplasty without concomitant Foraminotomy (n = 76, 4:1 ratio with F-group). Collected data included the time of onset and distribution of ULP (side and level). The site of Foraminotomy was recorded in the F-group. Results The F-group showed a significantly higher incidence of ULP than the candidates for the control group (15.1% vs. 3.1%, P Conclusions Our results indicate that the Foraminotomy procedure in the stenotic foramen is directly involved in ULP. Combined with a previous report suggesting that early-onset ULP is associated with thermal nerve damage, our results indicate that thermal nerve damage partly explains the increased incidence of ULP in the F-group.
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direct involvement of concomitant Foraminotomy for radiculomyelopathy in postoperative upper limb palsy in cervical laminoplasty
World Neurosurgery, 2020Co-Authors: Hiroyuki Ishiguro, Shota Takenaka, Masafumi Kashii, Yuichiro Ukon, Yukitaka Nagamoto, Masayuki Furuya, Takahiro Makino, Yusuke Sakai, Takashi KaitoAbstract:OBJECTIVE Although concomitant Foraminotomy has been reported to increase the risk of postoperative upper limb palsy (ULP) in cervical laminoplasty, the specific effects of concomitant Foraminotomy on ULP remain uncertain. This study aimed to clarify the effect of concomitant Foraminotomy on ULP in cervical laminoplasty. METHODS We identified 19 patients who developed ULP after laminoplasty with concomitant Foraminotomy for radiculomyelopathy with nerve root impingement (laminoplasty with concomitant Foraminotomy group [F-group]) from 4080 patients who underwent primary cervical laminoplasty at 27 affiliated institutions between 2012 and 2018. An age- and sex-matched control group comprised patients who developed ULP after laminoplasty without concomitant Foraminotomy (n = 76, 4:1 ratio with F-group). Collected data included the time of onset and distribution of ULP (side and level). The site of Foraminotomy was recorded in the F-group. RESULTS The F-group showed a significantly higher incidence of ULP than the candidates for the control group (15.1% vs. 3.1%, P < 0.001). The site of Foraminotomy was consistent with the distribution of ULP in 79% (15 of 19 patients) of the F-group. The F-group showed a significantly higher proportion of preoperative upper-limb muscle weakness (74% vs. 37%, P = 0.005) and early-onset ULP occurring by postoperative day 1 (63% vs. 33%, P = 0.02) compared with the control group. CONCLUSIONS Our results indicate that the Foraminotomy procedure in the stenotic foramen is directly involved in ULP. Combined with a previous report suggesting that early-onset ULP is associated with thermal nerve damage, our results indicate that thermal nerve damage partly explains the increased incidence of ULP in the F-group.
John A. Jane - One of the best experts on this subject based on the ideXlab platform.
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the posterior cervical Foraminotomy in the treatment of cervical disc osteophyte disease a single surgeon experience with a minimum of 5 years clinical and radiographic follow up
Journal of Neurosurgery, 2009Co-Authors: Jay Jagannathan, Jonathan H Sherman, Tom Szabo, Christopher I Shaffrey, John A. JaneAbstract:Object This study details long-term clinical and radiographic outcomes following single-level posterior cervical Foraminotomy for degenerative disc or osteophyte disease. Methods The authors conducted a retrospective review of 162 cases involving patients treated by a single surgeon using a posterior cervical Foraminotomy. Inclusion criteria were a minimum of 5 years' clinical and radiographic follow-up and unilateral single-level posterior cervical Foraminotomy for degenerative disease between C-3 and C-7. Patients who had undergone previous operations, those who underwent bilateral procedures, and those who underwent Foraminotomy as part of a larger laminectomy were excluded. The Neck Disability Index (NDI) was used for clinical follow-up, and radiographic follow-up was performed using static and dynamic lateral radiographs to compare focal and segmental alignment and changes in disc-space height. Results The mean presenting NDI score was 18 (range 2–39). The most common presenting symptoms were radicul...
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The posterior cervical Foraminotomy in the treatment of cervical disc/osteophyte disease: a single-surgeon experience with a minimum of 5 years' clinical and radiographic follow-up.
Journal of neurosurgery. Spine, 2009Co-Authors: Jay Jagannathan, Jonathan H Sherman, Tom Szabo, Christopher I Shaffrey, John A. JaneAbstract:Object This study details long-term clinical and radiographic outcomes following single-level posterior cervical Foraminotomy for degenerative disc or osteophyte disease. Methods The authors conducted a retrospective review of 162 cases involving patients treated by a single surgeon using a posterior cervical Foraminotomy. Inclusion criteria were a minimum of 5 years' clinical and radiographic follow-up and unilateral single-level posterior cervical Foraminotomy for degenerative disease between C-3 and C-7. Patients who had undergone previous operations, those who underwent bilateral procedures, and those who underwent Foraminotomy as part of a larger laminectomy were excluded. The Neck Disability Index (NDI) was used for clinical follow-up, and radiographic follow-up was performed using static and dynamic lateral radiographs to compare focal and segmental alignment and changes in disc-space height. Results The mean presenting NDI score was 18 (range 2–39). The most common presenting symptoms were radicul...
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Pediculotomy as an adjunct to posterior cervical hemilaminectomy, Foraminotomy, and discectomy.
Neurosurgical focus, 2002Co-Authors: K. Michael Webb, George J. Kaptain, Jonas M. Sheehan, John A. JaneAbstract:Currently the posterior approach undertaken to perform cervical hemilaminectomy and Foraminotomy provides sufficient exposure to treat the majority of lateral soft-disc herniations or osteophytes causing radiculopathy. Limitations imposed by the surgical field, however, often necessitate excessive retraction of the nerve root and epidural venous plexus, which may potentially exacerbate a preexisting radiculopathy or increase intraoperative blood loss. Partial resection of the inferior pedicle augments exposure and enlarges the neural foramen, thus facilitating decompression while minimizing manipulation of the nerve root and epidural venous plexus. With the patient in the prone position, partial hemilaminectomy and Foraminotomy are performed using a highspeed 3-mm diamond burr with continuous irrigation. The thecal sac and nerve root are exposed, and the overlying fibroareolar layer is coagulated and incised. With the nerve root protected and under direct vision, the superomedial portion of the inferior pedicle is removed. Nerve root decompression is then performed through this augmented exposure. Partial excision of the pedicle allows for more expeditious removal of the pathological elements causing cervical radiculopathy and requires minimal manipulation of the nerve root and epidural venous plexus. This procedure results in a potential decrease in transient postoperative radiculopathy and minimization of intraoperative blood loss. In addition, the resulting foraminal enlargement enhances the decompression provided by traditional Foraminotomy, even if discectomy is not performed.
Randolph Gray - One of the best experts on this subject based on the ideXlab platform.
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Posterior cervical Foraminotomy for the treatment of cervical radiculopathy.
Journal of neurosurgery. Spine, 2009Co-Authors: Michael G. Fehlings, Randolph GrayAbstract:Cervical radiculopathy remains a potentially disabling disease with a significant impact on patients’ quality of life. Despite conservative nonoperative treatment a large number of patients will end up needing surgical treatment. The most prevalent surgical options in this setting include anterior cervical discectomy and fusion (ACDF), posterior cervical Foraminotomy, and cervical arthroplasty.2 Importantly, posterior cervical Foraminotomy is an attractive option that may maintain cervical range of motion and minimize adjacent-segment degeneration. There are, however, no good data to guide the optimal timing of surgical treatment. Surgery is generally recommended when cervical-root–related dysfunction persists for more than 6–12 weeks despite nonsurgical treatment.12 A comparison of medical and surgical treatment published in Spine in 1999,12 showed that surgically treated patients had better outcomes with greater degrees of improvement, even though they had more neurological and nonneurological symptoms and more functional disability before treatment. In the current issue of Journal of Neurosurgery: Spine, Jagannathan et al.8 have reviewed a series of 162 cases involving patients with cervical radiculopathy who were treated with a posterior cervical Foraminotomy, with a mean follow-up of 77.3 months (range 60–177). This review has addressed not only the clinical outcome but also and more importantly the long-term radiological outcome of cervical spinal alignment following posterior cervical Foraminotomy. In this current series, 92% of patients showed an improvement of their Neck Disability Index scores from 18 (range 2–39) preoperatively to 8 (range 0–39) postoperatively. Ninety-five percent of patients with cervical radiculopathy experienced improvement of their symptoms. Loss of cervical lordosis (defined as segmental Cobb angle < 10°) was seen in 30 (18.5%) of patients. The overall cohort did not show any statistically significant progression of the focal or segmental kyphosis with time. Age over 60 years at the time of surgery and preoperative lordosis of less than 10° have been identified as risk factors of worsening sagittal alignment. Since the original description in the late 1940s, the surgical approaches to cervical radiculopathy secondary to laterally based discoligamentous and osseous pathology have been a choice between ACDF and posterior foraminal decompression. Many anatomical, pathophysiological, and patient factors influence the choice between these treatment approaches. Multiple studies have shown that in matched cohorts the clinical outcomes of ACDF and posterior Foraminotomy are similar. The most important factor that influences the approach to treatment of unilateral single-level radiculopathy is surgeon bias. There has been a resurgence of interest in posterior Foraminotomy, especially with recent popularization of minimally invasive surgery (MIS) techniques using tubular access.1,6,7,11 The 2 concerns with posterior foraminotomies are same-level degeneration/kyphosis secondary to partial resection of the facet joint and persistent neck and shoulder pain secondary to muscle stripping with the open procedure. In vitro studies have shown that segmental hypermobility of the cervical spine results if a Foraminotomy involves resection of more than 50% of the facet.13 In another cadaveric in vitro study Onan et al.9 demonstrated that isolated cervical facet joints are highly mobile in comparison with facet joints within the constraints of intact motion segments. This has prompted surgeons to be more conservative with the amount of facet joint resected when performing a posterior Foraminotomy. The surgical technique reported by John Jane’s team in this issue of Journal of Neurosurgery: Spine, which involves resecting the medial half of the facet joint to enable excellent nerve root decompression, importantly does not seem to have a deleterious effect on segmental stability or sagittal plane alignment. Jane’s team also identified the risk factors for delayed instability based on observations in a small subset of patients with worsening sagittal balance following surgery. These observations made by Jagannathan et al. in the current review, which were lackJ Neurosurg Spine 10:343–346, 2009 See the corresponding article in this issue, pp 347–356.