Trans-unco-discal approach

A combined anterior and lateral approach to cervical discs

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✓ A series of 40 patients with degenerative discopathy was effectively treated by means of a trans-unco-discal approach, which is a combined anterior and lateral approach to cervical discs. Interbody fusion is not performed except for special cases such as significant kyphosis and unstable cervical spine. Twenty patients who had this approach without interbody bone graft have been followed clinically and radiographically for 9 to 36 months. The author describes the surgical technique, complications, and results.

Article Information

Address reprint requests to: Akira Hakuba, M.D., Department of Neurosurgery, Osaka City University Medical School, Asahi-machi, Abenoku, Osaka, Japan.

© AANS, except where prohibited by US copyright law.

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Figures

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    Sketches of the operative approach. A. The anterior half of the sternocleidomastoid muscle is divided and the prevertebral space is exposed. The broken line indicates the site of division of the longus colli muscle. B. Removal of the portion of the lateral osteophyte anterior to the vertebral artery using the line of cleavage (arrow) on the body of C-5 and C-6. C. Uncectomy and removal of the remaining lateral osteophyte medial and posterior to the vertebral artery are performed inside the uncovertebral joint capsule, using the line of cleavage (arrow) on the body of C-6. D. Removal of the posterior spur from the vertebral body. The uncectomy and anterior foraminotomy have been performed (arrows 1 and 2). Arrow 3 indicates the line of cleavage to be resected. E. Removal of the intraforaminal osteophyte and anterior foraminotomy on the opposite side. Broken line (arrow) indicates the plane of resection of the opposite uncinate process and lateral osteophyte. F. Bone removal by way of this approach. AR = anterior ramus of C-6; C = carotid artery; D = dura; J = internal jugular vein; O = omohyoid muscle; S = sternocleidomastoid muscle; T = thyroid; V = vertebral artery.

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    Spine films, oblique view. Left: Preoperative film showing narrowing of the intervertebral foramen by a lateral spur at C5–C6 (arrow). Right: Postoperative film. The arrow points to anterior decompression of the intervertebral foramen achieved by the trans-unco-discal approach without interbody bone graft.

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    Vertebral arteriograms. Left: Preoperatively the left vertebral artery is displaced laterally and narrowed by the spur at C5–C6 (arrow). Right: Postoperatively, no stenosis of the left vertebral artery is visible (arrow).

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    Three examples of interbody fusion by this surgical approach without bone graft.

References

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  • 6.

    Verbiest H: A lateral approach to the cervical spine: technique and indications. J Neurosurg 28:1912031968Verbiest H: A lateral approach to the cervical spine: technique and indications. J Neurosurg 28:191–203 1968

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