Acta Neurochirurgica

, Volume 154, Issue 10, pp 1797–1802 | Cite as

Transvertebral anterior key hole foraminotomy without fusion for the cervicothoracic junction

  • Mikinobu TakeuchiEmail author
  • Masakazu Takayasu
  • Muneyoshi Yasuda
  • Mitsuhiro Kamiya
  • Takashi Inukai
  • Naoki Matsuo
  • Koji Osuka
Technical Note



Various surgical procedures have been used to repair disc herniations and osteophytes at the cervicothoracic junction. Among these procedures, transvertebral anterior foraminotomy without fusion is a relatively less invasive, safe and useful method, although the majority of spinal surgeons remain unfamiliar with this method. We describe the surgical procedure for a transvertebral anterior keyhole foraminotomy without fusion at the cervicothoracic junction, and we assess the middle-term clinical and radiological outcomes.


Of 118 patients undergoing this surgery in our institute between 2007 and 2010, five (4.2 %) had C8 radiculopathy causing C7/T1 disc herniations or osteophytes. We studied five patients who underwent trans-C7 vertebral keyhole foraminotomy without fusion. We retrospectively examined clinical data, pre- and postoperative neurological status.


In all cases, surgical decompression was successfully achieved without difficulty when accessing the pathology. No complications related to the surgical procedure were reported. The follow-up period was 12–28 (mean 20) months. In all patients, the visual analogue scale (VAS) due to radicular pain immediately decreased after the operation and did not increase thereafter. The mean VAS decreased from 7.8 (4.5–9.6) to 1.0 (0–2.1). The Cobb angle at C2-T1 in a neutral position improved from −12.6 (−2.8 to −24.7) degrees to −6.9 (4.2 to −25.4). The postoperative C7/T1 disc height decreased from 5.4 to 4.9 mm, indicating minimal loss.


This procedure allows for direct access to the pathology and is less invasive. In this study, we clarified that this technique yields excellent radiological and clinical outcomes.


Anterior foraminotomy without fusion C8 radiculopathy Transvertebral approach Cervical disc herniation 


Disclosure of funding and the source of financial support and industry affiliations

The manuscript submitted does not contain information about medical device(s)/drug(s). No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Conflicts of interest


Supplementary material


Patient placed in spine position. A 3-cm transverse skin incision was made along with the winkle. I dissected the soft tissue along with inside SCM. Just after exposing the vertebral body surface unilaterally, I injected blue dye in the C7/T1 disc level as a landmark. Right longs coli muscle was retracted laterally. A 7-mm square keyhole was made in the caudo-lateral cornar toward the C7/T1 disc level. After making the keyhole, the posterior longitudinal ligament was cut to find the dural sac and nerve root. The disc protrusion that compressed the C8 nerve root was removed. We can see that this is the C8 nerve root. Finally, we irrigated the operative field and checked secure hemostasis. The skin was sutured without drainage (MPG 13910 kb)


  1. 1.
    Apfelbaum RI, Kriskovich MD, Haller JD (2000) On the incidence, cause, and prevention of recurrent laryngeal nerve palsies during anterior cervical spine surgery. Spine 25:2906–2912PubMedCrossRefGoogle Scholar
  2. 2.
    Boockvar JA, Philips MF, Telfeian AE, O’Rourke DM, Marcotte PJ (2001) Results and risk factors for anterior cervicothoracic junction surgery. J Neurosurg 94:12–17PubMedGoogle Scholar
  3. 3.
    Burke JP, Gerszten PC, Welch WC (2005) Iatrogenic vertebral artery injury during anterior cervical spine surgery. Spine J 5:508–514PubMedCrossRefGoogle Scholar
  4. 4.
    Burke TG, Caputy A (2000) Microendocsopic posterior cervical foraminotomy: a cadaveric model and clinical application for cervical radiculopathy. J Neurosurg 93:126–129PubMedGoogle Scholar
  5. 5.
    Cauchoix J, Binet JP (1957) Anterior surgical approaches to the spine. Ann R Coll Surg Engl 21:234–243PubMedGoogle Scholar
  6. 6.
    Cloward RB (1971) Complications of anterior cervical disc operation and their treatment. Surgery 69:175–182PubMedGoogle Scholar
  7. 7.
    Gieger M, Roth PA, Wu JK (1995) The anterior cervical approach to the cervicothoracic junction. Neurosurgery 37:704–709PubMedCrossRefGoogle Scholar
  8. 8.
    Hacker RJ, Miller CG (2003) Failed anterior cervical foraminotomy. J Neurosurg 98:126–130PubMedGoogle Scholar
  9. 9.
    Harrop JS, Silva MT, Sharan AD, Dante SJ, Simeone F (2003) Cervicothoracic radiculopathy treated using posterior cervical foraminotomy/discectomy. J Neurosurg 98:131–136PubMedCrossRefGoogle Scholar
  10. 10.
    Hong WJ, Kim WK, Park CW, Lee SG, Yoo CJ, Lim YB, Jho HD (2006) Comparison between transuncal approach and upper vertebral transcorporeal approach for unilateral cervical radiculopathy—a preliminary report. Minim Invasive Neurosurg 49:296–301PubMedCrossRefGoogle Scholar
  11. 11.
    Jho HD (1996) Microsurgical anterior cervical foramiotomy for radiculopathy: a new approach to cervical disc herniation. J Neurosurg 84:155–160PubMedCrossRefGoogle Scholar
  12. 12.
    Kunert P, Prokopeinko M, Marchel A (2010) Posterior microlaminoforaminotomy for cervical disc herniation. Neurol Neurochir Pol 44:375–384PubMedGoogle Scholar
  13. 13.
    Lee JY, Lohn M, Impekoven P, Koebke J, Ernestus RI, Ebel H, Klug N (2006) Small keyhole transuncal foraminotomy for unilateral cervical radiculopathy. Acta Neurochir 148:951–958CrossRefGoogle Scholar
  14. 14.
    Luk KD, Cheung KM, Leong JC (2002) Anterior approach to the cervicothoracic junction by unilateral or bilateral manubriotomy: a report of five cases. J Bone Joint Surg AM 84:1013–1017PubMedGoogle Scholar
  15. 15.
    Orlando ER, Caroli E, Ferrante L (2003) Management of the cervical esophagus and hypofarinx perforations complicating anterior cervical spine surgery. Spine 28:E290–E295PubMedGoogle Scholar
  16. 16.
    Ozer AF, Kaner T, Sasani M, Oktenoglu T, Cosar M (2009) Anterior approach to disc herniation with modified anterior microforaminotomy at C7-T2: technical note. Spine 34:1879–1883PubMedCrossRefGoogle Scholar
  17. 17.
    Park CH, Kim CJ, Chung KS (1996) Results of anterior cervical discectomy without interbody fusion. J Korean Neurosurg Soc 25:1371–1376Google Scholar
  18. 18.
    Post NH, Cooper PR, Frempong-Boadu AK, Costa ME (2006) Unique features of herniated discs at the cervicothoracic junction: clinical presentation, imaging, operative management, and outcome after anterior decompressive operation in 10 patients. Neurosurgery 58:497–501PubMedGoogle Scholar
  19. 19.
    Saringer WF, Beddy R, Mobauer-huhmann I, Regatschnig R, Reddy M, Tschabitscher M, Knosp E (2003) Endoscopic anterior cervical foraminotomy for unilateral radiculopathy: anatomical morphometric analysis and preliminary clinical experience. J Neurosurg 98:171–180PubMedGoogle Scholar
  20. 20.
    Shah KC, Rajshekhar V (2004) Reliability of diagnosis of soft cervical disc prolapse using Spurling’s test. Br J Neurosurg 18:480–483Google Scholar
  21. 21.
    SPURLING RG (1947) Cervical intervertebral disks. J Kans City Mo Southwest Clin Soc 23:7–10Google Scholar
  22. 22.
    Takayasu M, Shibuya M, Suzuki Y, Sugita K (1995) The use of self-retaining retractors in surgery for spinal cord tumor: technical note. Neurosurgery 37:148–150PubMedCrossRefGoogle Scholar
  23. 23.
    Teng H, Hsaing J, Wu C, Wang M, Wei H, Yang X, Xiao J (2009) Surgery in the cervicothoracic junction with an anterior low suprasternal approach alone or combined with manubriotomy and sternotomy: an approach selection method based on the cervicothoracic angle. J Neurosurg Spine 10:531–542PubMedCrossRefGoogle Scholar
  24. 24.
    Yamazaki S, Kokubun S, Ishii Y, Tanaka Y (2003) Courses of cervical disc herniation causing myelopathy or radiculopathy: an analysis based on computed tomo-graphic discograms. Spine 28:1171–1175PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Mikinobu Takeuchi
    • 1
    Email author
  • Masakazu Takayasu
    • 1
  • Muneyoshi Yasuda
    • 1
  • Mitsuhiro Kamiya
    • 1
  • Takashi Inukai
    • 1
  • Naoki Matsuo
    • 1
  • Koji Osuka
    • 1
  1. 1.Departments of Neurological Surgery and Orthopedics SurgeryAichi Medical University HospitalNgakuteJapan

Personalised recommendations