Indian Spine Journal (Jan 2018)
Transforaminal approach to cervical spine with use of cervical pedicle screws: Technical description of a novel approach
Abstract
Background: The success and popularity of the transforaminal approach in the lumbar spine has been made possible by the routine use of pedicle screws in the lumbar spine. Transforaminal approach in the cervical spine can give access to the disc and the vertebral body anteriorly and avoid an additional anterior approach in certain clinical situations. We report technical aspects of transforaminal approach in the lower cervical spine with the authors learning experience. Materials and Methods: Fifteen patients underwent transforaminal approach with cervical pedicle screw (CPS) instrumentation at our institute from July 2011 to October 2014. Five patients underwent foraminal decompression alone (Group-1); 9 patients underwent transforaminal cervical interbody fusion (TCIF) with foraminal decompression, discectomy, and interbody bone grafting (Group-2); and 1 patient underwent partial corpectomy (Group-3). All patients were evaluated for the placement of pedicle screws, for clinical improvement using modified Japanese Orthopaedic Association (mJOA) scoring and interbody graft positioning. The average follow-up was 34.6 months (22–64 months). Results: The average age was 45 years (25–80 years). The average blood loss was 198 ml (100–450 ml) and the average operative time was 142 min (90–200 min). Interbody graft pieces extruded anteriorly in 4 patients (Group-II). The preoperative average mJOA score of 11.4 (0–15) improved to 15.73 (0–18) at final followup. Conclusion: Transforaminal approach in lower cervical spine, though has a learning curve, seems to be a feasible technique along with the use of cervical pedicle screws. Safety and reproducibility of the approach needs to be substantiated with a larger study. Further, TCIF can avoid an additional anterior surgery in certain situations in the cervical spine.
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