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He T, Zhang J, Yu T, Wu J, Yuan T, Liu R, Yun Z, Du H, Qi L, An J, Xue W, Nie X, Liu Q. Comparative Analysis of the Biomechanical Characteristics After Different Minimally Invasive Surgeries for Cervical Spondylopathy: A Finite Element Analysis. Front Bioeng Biotechnol 2021; 9:772853. [PMID: 34976969 PMCID: PMC8716838 DOI: 10.3389/fbioe.2021.772853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/22/2021] [Indexed: 11/26/2022] Open
Abstract
Minimally invasive surgeries, including posterior endoscopic cervical foraminotomy (PECF), microsurgical anterior cervical foraminotomy (MACF), anterior transdiscal approach of endoscopic cervical discectomy (ATd-ECD), and anterior transcorporeal approach of endoscopic cervical discectomy (ATc-ECD), have obtained positive results for cervical spondylotic radiculopathy. Nonetheless, there is a lack of comparison among them regarding their biomechanical performance. The purpose of this study is to investigate the biomechanical changes of operated and adjacent segments after minimally invasive surgeries compared to a normal cervical spine. A three-dimensional model of normal cervical vertebrae C3–C7 was established using finite element analysis. Afterwards, four surgical models (PECF, MACF, ATd-ECD, and ATc-ECD) were constructed on the basis of the normal model. Identical load conditions were applied to simulate flexion, extension, lateral bending, and axial rotation of the cervical spine. We calculated the range of motion (ROM), intradiscal pressure (IDP), annulus fibrosus pressure (AFP), uncovertebral joints contact pressure (CPRESS), and facet joints CPRESS under different motions. For all circumstances, ATc-ECD was close to the normal cervical spine model, whereas ATd-ECD significantly increased ROM and joints CPRESS and decreased IDP in the operated segment. PECF increased more the operated segment ROM than did the MACF, but the MACF obtained maximum IDP and AFP. Except for ATc-ECD, the other models increased joints CPRESS of the operated segment. For adjacent segments, ROM, IDP, and joints CPRESS showed a downward trend in all models. All models showed good biomechanical stability. With their combination biomechanics, safety, and conditions of application, PECF and ATc-ECD could be appropriate choices for cervical spondylotic radiculopathy.
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Lee BH, Park JH, Lee JY, Jeon HJ, Park SW. Efficiency of minimal oblique resection of the uncinate process during an anterior cervical discectomy and fusion. Medicine (Baltimore) 2021; 100:e26790. [PMID: 34397831 PMCID: PMC8341223 DOI: 10.1097/md.0000000000026790] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/09/2021] [Indexed: 01/04/2023] Open
Abstract
Hypertrophy of the uncinate process (UP) can cause radiculopathy. Minimal UP resection is considered to remove the lesion while minimizing the risk of complications. This study aimed to elucidate the surgical results of minimal oblique resection of the UP. This study is a retrospective review of about sixty segments in 34 patients who underwent anterior cervical discectomy and fusion (ACDF) with minimal oblique uncinectomy between 2016 and 2018. The cross-sectional area of the UP was measured pre- and postoperatively. The interspinous distance, segmental Cobb angle, subsidence, fusion rate, surgical time, estimated blood loss, and postoperative complications were evaluated. The mean resected areas of the UP were 17.4 ± 8.7 mm2 (25.9%) on the right and 17.3 ± 11.2 mm2 (26.2%) on the left. The difference in interspinous distance in flexion-extension was 7.1 ± 3.2 and 1.6 ± 0.6 mm pre- and postoperatively, respectively (P = .000). The fusion rate after ACDF was 91.7% when measured according to segment (55/60) and 91.2% when measured according to patients (31/34). The difference in the segmental Cobb angle in flexion-extension was 8.3 ± 6.2° and 1.9 ± 0.3° pre and postoperatively, respectively (P = .000). Subsidence occurred in 4 (11.8%) patients and 5 (8.3%) segments. The average surgical time per segment was 68.8 ± 9.3 minute, and the estimated blood loss was 48.5 ± 25.0 mL. Postoperative complications comprised 1 case each of neck swelling, wound infection, pneumonia, and gastrointestinal bleeding. Our findings therefore revealed that minimal oblique uncinectomy during an ACDF can maintain the stability of the uncovertebral joint while sufficiently decompressing the neural foramen.
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Affiliation(s)
- Byoung Hun Lee
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
- Graduate School of Kangwon National University, Republic of Korea
| | - Jong Hwa Park
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Jong Young Lee
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Hong Jun Jeon
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Seung-Woo Park
- Departments of Neurosurgery, Kangwon National University Hospital, Chuncheon, Republic of Korea
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Cui S, Nasser AE, Ma L, Su P, Su D, Liao Z. Analysis of the morphometric change in the uncinate process of the cervical spondylosis patients: A study of radiological anatomy. J Orthop Translat 2020; 24:32-8. [PMID: 32612932 DOI: 10.1016/j.jot.2020.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 03/23/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose Although there are many researches that focus on the relationship between the vertebral artery and uncinate process (UP), there were no publications concerning difference in the dimensions of the UP between the normal spine and degenerative spine, especially in Chinese patient. The purpose of this study is to determine the anatomic parameters that can be used as a guide for the procedure in intervertebral foramen decompression and for analysis of the morphometric change in the UP of the cervical spondylosis patients. Methods Forty patients from January 2016 to January 2019 were enrolled in this study. Three-dimensional computed tomography scans of the cervical spine were performed. The patients were subdivided into two groups which were nondegenerative cervical spine group (20 cases) and degenerative cervical spine group (20 cases). Six parameters concerning the height, width and angle of the UP were measured. Results In nondegenerative group, the average pedicle width was 3.63 mm–5.91 mm from C3 to C7. The average width of safe UP resection will be 3.06 mm at C3, 3.12 mm at C4, 3.28 mm at C5, 2.74 mm at C6 and 2.01 mm at C7. The average safe depth will be 6.04 mm at C3, 6.52 mm at C4, 7.61 mm at C5, 6.07 mm at C6 and 5.09 mm at C7. There are statistic difference between degenerative group and nondegenerative group, especially in the parameter minimum height of UP, maximum height of UP, medial border's distance of UP and later border's distance of UP. Conclusion In this retrospective study, our results suggest that for the Chinese patients who suffered from cervical spondylosis could be performed intervertebral foraminotomy decompression by resecting part of the UP. The safe range within the spinal canal was up to 6.73 mm of width between inferior vertebral endplate and superior vertebral endplate in the intervertebral space and up to 5.09 mm of depth from medial border of the UP to the lateral side atC3 to C7 without interfering the spinal nerve root and vertebral artery. The translational potential of this article Our study found the safe margin to perform intervertebral foramen decompression to the UP for the cervical spondylosis patients. This may help to improve safeness of the surgical procedure and provide data for future robotic surgery.
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Abstract
The anterior approach to the cervical spine is commonly utilized for a variety of degenerative, traumatic, neoplastic, and infectious indications. While many potential complications overlap with those of the posterior approach, the distinct anatomy of the anterior neck also presents a unique set of hazards. We performed a systematic review of the literature to assess the etiology, presentation, natural history, and management of these complications. Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), a PubMed search was conducted to evaluate clinical studies and case reports of patients who suffered a complication of anterior cervical spine surgery. The search specifically included articles concerning adult human subjects, written in the English language, and published from 1989 to 2019. The PubMed search yielded 240 articles meeting our criteria. The overall rates of complications were as follows: dysphagia 5.3%, esophageal perforation 0.2%, recurrent laryngeal nerve palsy 1.3%, infection 1.2%, adjacent segment disease 8.1%, pseudarthrosis 2.0%, graft or hardware failure 2.1%, cerebrospinal fluid leak 0.5%, hematoma 1.0%, Horner syndrome 0.4%, C5 palsy 3.0%, vertebral artery injury 0.4%, and new or worsening neurological deficit 0.5%. Morbidity rates in anterior cervical spine surgery are low. Nevertheless, the unique anatomy of the anterior neck presents a wide variety of potential complications involving vascular, aerodigestive, neural, and osseous structures.
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Affiliation(s)
- Timothy J Yee
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Kevin Swong
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
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Segar AH, Riccio A, Smith M, Protopsaltis TS. Total uncinectomy of the cervical spine with an osteotome: technical note and intraoperative video. J Neurosurg Spine 2019; 31:1-4. [PMID: 31443083 DOI: 10.3171/2019.6.spine19332] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/05/2019] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- Anand H Segar
- 1Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health; and
| | - Alexander Riccio
- 1Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health; and
| | - Michael Smith
- 2Department of Neurosurgery, NYU Langone Medical Center, NYU Langone Health, New York, New York
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Kong QJ, Sun XF, Wang Y, Sun JC, Sun PD, Lv HD, Wang ZQ, Xu XM, Guo YF, Shi JG. Risk assessment of vertebral artery injury in anterior controllable antedisplacement and fusion (ACAF) surgery: a cadaveric and radiologic study. Eur Spine J 2019; 28:2417-2424. [PMID: 31428861 DOI: 10.1007/s00586-019-06111-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 08/05/2019] [Accepted: 08/11/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE We have introduced a novel surgery technique named anterior controllable antedisplacement and fusion (ACAF) for the treatment of ossification of the posterior longitudinal ligament. As reported, the satisfactory postoperative outcome can be attributed to the larger decompression width. However, it may associate with high prevalence of vertebral artery injury (VAI) theoretically. Thus, assessment of the vulnerability of vertebral artery in ACAF is of great importance. METHODS Computed tomographic scan data of 28 patients were retrospectively studied. Seven radiographic parameters were evaluated: uncinate process (UP) tips distance, transverse foramen (TF)-UP tips distance, TF-LWL (the ipsilateral limited wedging line) distance, the limited distance of lateral decompression, the maximum oblique angle of LWL, TF-LWG (the lateral wall of groove) distance, and width of groove. Eleven fresh cadaveric spines undergoing ACAF surgery were also studied. Two anatomic parameters were evaluated: width of groove and LWG-TF distance. RESULTS The UP tips distance increased from C3 to C6 and tended to be larger in males. The UP tip-TF distance and LWL-TF distance were smallest at C4, but both were larger than 2 mm. Maximum oblique angle decreased from C3 to C6. Postoperatively, both radiographic and cadaveric measurements showed the width of groove was larger than UP tips distance, but LWG-TF distance was larger than 2 mm in all levels. CONCLUSION UP can be used as anatomical landmarks to avoid VAI during ACAF surgery. Radiographic and cadaveric measurements verified the safety of ACAF surgery, even for those cases with wedging and lateral slotting.
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Affiliation(s)
- Qing-Jie Kong
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Xiao-Fei Sun
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Yuan Wang
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China.
| | - Jing-Chuan Sun
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Pei-Dong Sun
- Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, Southern Medical University, No. 1023 Shatai Road, Baiyun District, Guangzhou, 510515, People's Republic of China
| | - Hong-di Lv
- The 990th Hospital of People's Liberation Army, No. 1 Fenghuang Road, Zhumadian, 463000, Henan Province, People's Republic of China
| | - Zi-Qin Wang
- Henan Provincial Corps Hospital of Chinese People's Armed Police Forces, No. 1 Kangfu Zhong Street, Zhengzhou, 450000, Henan Province, People's Republic of China
| | - Xi-Ming Xu
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Yong-Fei Guo
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Jian-Gang Shi
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China.
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Raveendranath V, Kavitha T, Umamageswari A. Morphometry of the Uncinate Process, Vertebral Body, and Lamina of the C3-7 Vertebrae Relevant to Cervical Spine Surgery. Neurospine 2019; 16:748-755. [PMID: 31284340 PMCID: PMC6944996 DOI: 10.14245/ns.1836272.136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 03/04/2019] [Indexed: 11/19/2022] Open
Abstract
Objective The cervical spine consists of 4 typical and 3 atypical vertebrae. The uncinate process is one of the unique features of the cervical vertebrae. Uncinectomy and uncoforaminotomy are widely used to decompress the nerve in the intervertebral foramen and to remove osteophytes from the uncinate process. Morphometric analyses of the uncinate process help spine surgeons obtain a 3-dimensional orientation for approaching the cervical spine with minimal risk to the surrounding vascular and neural structures. This study aims to analyze the morphometry of uncinate process of cervical vertebrae with relevant to cervical spine surgery.
Methods Eighty dry adult cervical vertebrae were studied, and 11 parameters were measured. Seven parameters were paired and 4 were unpaired.
Results The height of the uncinate process progressively increased from C3 to C6 and decreased at C7. The length of the uncinate process increased from C3 to C6–7. The width was greatest at C6 and smallest at C3. The vertebral body width and anteroposterior diameter gradually increased from C3 to C7. The parameters of the lamina also increased from C3 to C7.
Conclusion Precise knowledge about the cervical vertebrae is useful for diagnosing both common and uncommon causes of symptoms and for choosing an appropriate approach. Thus, it helps to increase the success rate of cervical surgery.
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Affiliation(s)
- Veeramani Raveendranath
- Department of Anatomy, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Thangarasu Kavitha
- Department of Anatomy, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
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Oh SW, Singh R, Adsul NM, Noh JH, Park JH, Kim HS, Jang IT, Oh SH. Anatomical Relationship of the Vertebral Artery With the Lateral Recess: Clinical Importance for Posterior Cervical Foraminotomy. Neurospine 2019; 16:34-40. [PMID: 30943705 PMCID: PMC6449823 DOI: 10.14245/ns.1836304.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 01/14/2019] [Indexed: 11/24/2022] Open
Abstract
Objective Vertebral artery injuries during posterior cervical foraminotomy are rare, but can be fatal. Therefore, we investigated the anatomical correlation between the lateral recess and the vertebral artery.
Methods On axial cuts of cervical magnetic resonance imaging from 108 patients, we measured the distance between the vertebral arteries and the medial border of the facet joints. The anatomical vertebro-facet distance (AVFD), surgical vertebro-facet distance (SVFD), and vertebro-facet angle (VFA) were measured.
Results The mean AVFD values on the right side at the C3–4, C4–5, C5–6, and C6–7 levels showed statistically significant differences. On the right side, the mean SVFD values were equivalent to the AVFD values. The mean values of the VFA on the right side at all levels showed statistically significant differences. For all measurements, the greatest differences were seen between the C5–6 and C6–7 levels, and higher levels were associated with smaller distances from the lateral recess. The mean values of the AVFD on the right and left sides showed statistically significant differences at all levels, and the distances on the left were smaller than those on the right.
Conclusion The vertebral artery is closer to the lateral recess at higher cervical levels than at lower cervical levels. The largest distances were found at the C5–6 and C6–7 levels, and the left vertebral arteries were closer to the lateral recess than the right vertebral arteries.
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Affiliation(s)
- Sung Woon Oh
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Korea
| | - Ravindra Singh
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Korea
| | | | - Jung Hoon Noh
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Korea
| | - Jun Hwan Park
- Medical School University of Debrecen, Debrecen, Hungary
| | - Hyeun-Sung Kim
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Korea
| | - Il-Tae Jang
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Korea
| | - Seong Hoon Oh
- Department of Neurosurgery, Nanoori Incheon Hospital, Incheon, Korea
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Sun JC, Yang HS, Shi JG, Yuan W, Xu XM, Shi GD, Jia LS. Morphometric Analysis of the Uncinate Process as a Landmark for Anterior Controllable Antedisplacement and Fusion Surgery: A Study of Radiologic Anatomy. World Neurosurg 2018; 113:e101-e107. [DOI: 10.1016/j.wneu.2018.01.181] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/24/2018] [Accepted: 01/25/2018] [Indexed: 11/16/2022]
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Pakzaban P. Ultrasonic total uncinectomy: a novel technique for complete anterior decompression of cervical nerve roots. Neurosurgery 2015; 10 Suppl 4:535-41; discussion 541. [PMID: 25181437 DOI: 10.1227/neu.0000000000000549] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In standard anterior cervical diskectomy, complete resection of the uncinate process is not commonly attempted because of the risk of injury to the vertebral artery. This may result in incomplete decompression of the nerve root when there is severe osseous foraminal stenosis. OBJECTIVE To demonstrate the feasibility of total uncinectomy with an ultrasonic bone dissector in patients with concomitant central and foraminal stenosis requiring anterior decompression and fusion. METHODS A case series of patients with cervical radiculopathy or myeloradiculopathy who underwent single-level or multilevel ultrasonic total uncinectomy (UTU) in combination with anterior cervical diskectomy and fusion is presented. The uncinate process was amputated along its base with an ultrasonic bone dissector and removed en bloc to expose the cervical root and the vertebral artery. Data gathered in accordance with routine practice were analyzed retrospectively. RESULTS Forty-four uncinate processes were resected in 38 patients. No UTU procedures were aborted because of technical difficulties, and no vertebral artery or nerve root injury occurred. Mean follow-up was 28 weeks (range, 14-37 weeks). Mean Neck Disability Index and Visual Analog Scale scores for neck and arm pain improved from 42%, 4.9%, and 6.8% to 23%, 2.6%, and 2.1%, respectively. Postoperative computed tomography and oblique radiographs revealed complete decompression of the neural foramen after UTU. CONCLUSION UTU is a safe and effective technique for complete decompression of cervical nerve roots when the coexistence of central and foraminal pathology dictates an anterior approach. The surgical technique is described in detail.
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