Total uncinate process resection or uncinectomy is often required in the setting of severe foraminal stenosis or cervical kyphosis correction. The proximity of the uncus to the vertebral artery, nerve root, and spinal cord makes this a challenging undertaking. Use of a high-speed burr or ultrasonic bone dissector can be associated with direct injury to the vertebral artery and thermal injury to the surrounding structures. The use of an osteotome is a safe and efficient method of uncinectomy. Here the authors describe their technique, which is illustrated with an intraoperative video.
ABBREVIATIONSPLL = posterior longitudinal ligament; UP = uncinate process; VA = vertebral artery.
Correspondence Anand H. Segar: NYU Langone Orthopedic Hospital, New York, NY. email@example.com.INCLUDE WHEN CITING Published online August 23, 2019; DOI: 10.3171/2019.6.SPINE19332.Disclosures Dr. Protopsaltis is a consultant for Globus, K2M, NuVasive, Medicrea, and Innovasis. Dr. Riccio has direct stock ownership in Revivo Medical.
AmesCPSmithJSScheerJKShaffreyCILafageVDevirenV: A standardized nomenclature for cervical spine soft-tissue release and osteotomy for deformity correction: clinical article. J Neurosurg Spine19:269–2782013
EbraheimNALuJHamanSPYeastingRA: Anatomic basis of the anterior surgery on the cervical spine: relationships between uncus-artery-root complex and vertebral artery injury. Surg Radiol Anat20:389–3921998
EbraheimNA, LuJ, HamanSP, YeastingRA: Anatomic basis of the anterior surgery on the cervical spine: relationships between uncus-artery-root complex and vertebral artery injury. 20:389–392, 199810.1007/BF016531279932321)| false
GüvençerM, MenS, NaderiS, KirayA, TetikS: The V2 segment of the vertebral artery in anterior and anterolateral cervical spinal surgery: a cadaver angiographic study. 108:440–445, 20061595367410.1016/j.clineuro.2005.04.006)| false
SmithMD, EmerySE, DudleyA, MurrayKJ, LeventhalM: Vertebral artery injury during anterior decompression of the cervical spine. A retrospective review of ten patients. 75:410–415, 1993849620910.1302/0301-620X.75B3.8496209)| false
TaraziNMunigangaiahSJadaanMMcCabeJP: Comparison of thermal spread with the use of an ultrasonic osteotomy device: Sonopet ultrasonic aspirator versus misonix bonescalpel in spinal surgery. J Craniovertebr Junction Spine9:68–722018
TaraziN, MunigangaiahS, JadaanM, McCabeJP: Comparison of thermal spread with the use of an ultrasonic osteotomy device: Sonopet ultrasonic aspirator versus misonix bonescalpel in spinal surgery. 9:68–72, 201829755240)| false
TubbsRS, RompalaOJ, VermaK, MortazaviMM, BenningerB, LoukasM, : Analysis of the uncinate processes of the cervical spine: an anatomical study. 16:402–407, 201210.3171/2011.12.SPINE1154122264177)| false