gms | German Medical Science

Objective: Recurrent radiculopathy after ACDF and fusion is due to recurrent formation of spondylophytes at the Neuroforamen or by remnants left during prior surgery now offending the foramen. In both cases revision surgery is warranted. Anterior uncoforaminotomy may be an alternative approach directly to the neuroforamen without the need to exchange the fusion device. The purpose of this study was to evaluate the postoperative outcome using Uncoforaminotomy in patients with ACDF and recurrent radiculopathy.

Methods: 7 patients were surgically treated with uncoforaminotomy in the presence of recurrent radiculopathy. Patients were evaluated preoperatively with Spiral-CT. Inclusion criteria were foraminal osseous pathology offending the nerve root and solid bone construct (Fusion) present. Furthermore, a CT-guided nerve root anesthesia had been positive. Uncoforaminotomy was done lateral to the fusion device removing the retrospondylophytes at the level of the nerve root. Postoperatively a CT scan was done to evaluate the neuroforamen and the outcome was assessed at discharge and at six month postoperatively.

Results: All patients had recurrent radiculopathy. CT scans revealed remnants of osseous spurs in two cases and recurrent bone formation in the other 5 cases. In all patients anterior Uncoforaminotomy was successful in removing the offending pathology. No instability occured in the postoperative course. Immediately after surgery 6 patients were without radicular pain and remained so at follow-up evaluation. One patient continued to have radicular pain even though the postoperative CT revealed a sufficiently enlarged neuroforamen.

Conclusions: According to our results uncoforaminotomy is an alternative method in the surgical treatment of recurrent radiculopathy after ACDF and fusion. The offending pathology is directly approached and can be removed without the need for revising the prior ACDF.