Anterior cervical foraminotomy: Surgiologic evolution of anterior cervical disc surgery

Abstract

Following the concept of functional spine surgery, the senior author introduced anterior cervical foraminotomy in 1996. This procedure directly eliminates compressive pathology via an anterior approach while preserving the functioning motion segment. Since then, several variations of the technique have been developed. Instead of the original medial-to-lateral bone opening at the lateral aspect of the cervical spine, a direct lateral-to-medial bone drilling from the medial margin of the vertebral artery has been adopted. For compressive pathology involving the posterolateral spinal canal, three variations of surgical approaches have been developed: the lower vertebral transcorporeal, transuncal, and upper vertebral transcorporeal approaches. Each variation uses a different surgical trajectory made at the lateral portion of the cervical spine to access the compressive pathology. The anterior foraminoplasty technique can reconstruct the stenotic neural foramen to a normal shape by eliminating bone spurs along the axis of the medial wall of the neural foramen. This article details the various techniques for anterior cervical foraminotomy.