Clinical Study| Volume 21, ISSUE 6, P915-923, June 2021

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Long-term clinical and radiological outcomes of anterior uncoforaminotomy for unilateral single-level cervical radiculopathy: retrospective cohort study

Published:February 02, 2021DOI:



      Anterior cervical discectomy and fusion is a common procedure for degenerative cervical radiculopathy. In 1996, Dr. H.D. Jho reported an operative technique allowing nerve root decompression via anterior uncoforaminotomy whereas avoiding fusion.


      To assess long-term clinical and radiological outcomes of anterior uncoforaminotomy in patients with degenerative cervical spine pathology.


      A single clinic, retrospective cohort study.


      Adult patients who underwent anterior uncoforaminotomy from 2013 to 2018.


      Clinical outcomes were assessed using VAS, NDI, SF-36 criteria. Radiological parameters included sagittal balance, disc height and White anPanjabi criterion.


      All patients underwent unilateral single-level anterior uncoforaminotomy, and long-term clinical and radiologic follow up was carried out. Clinical outcomes were assessed using VAS, NDI, SF-36 criteria. Radiological parameters evaluated included sagittal balance, disc height and White and Panjabi criteria (3.5 mm of translation, 11 degrees of kyphosis). The mean follow-up period was 33.3 ± 10.6 months (range 12–57 months).


      All measures of clinical outcome improved. VAS (neck) and VAS (arm) decreased 3 [2; 4] and 5 [3; 5.2] points (median [interquartile range]), respectively (p<0.001); NDI improved from 0.38 [0.36; 0.4], to 0.29 [0.22; 0.34] (p<0.001). Two patients (6%) required additional surgery one year after operation. There were no complications in the perioperative period. Disc height decreased 0.8 mm [0.1; 2.1] (p<0.001). All patients retained stability of the cervical spine based on White and Panjabi criteria. Sagittal balance parameters did not change significantly.


      Uncoforaminotomy is an effective and safe method to decompress a unilateral single-level nerve root in degenerative cervical radiculopathy whereas preserving anatomy and motion of the cervical spine.

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        • Wong JJ
        • Côté P
        • Quesnele JJ
        • Stern PJ
        • Mior SA
        The course and prognostic factors of symptomatic cervical disc herniation with radiculopathy: a systematic review of the literature.
        Spine J. 2014; 14: 1781-1789
        • Radhakrishnan K
        • Litchy WJ
        • Michael O'Fallon W
        • Kurland LT
        Epidemiology of cervical radiculopathy: a population-based study from Rochester, Minnesota, 1976 through 1990.
        Brain. 1994; 117 (April): 325-335
        • Caridi JM
        • Pumberger M
        • Hughes AP
        Cervical radiculopathy: a review.
        HSS J. 2011; 7 (Oct): 265-272
        • Iyer S
        • Kim HJ
        Cervical radiculopathy.
        Curr Rev Musculoskelet Med. 2016; 9: 272-280
        • Semmes RE
        • Murphey F.
        Ruptured intervertebral disks; cervical, thoracic and lumbar, lateral and central.
        Surg Clin North Am. 1954; 34: 1095-1111
        • Mixter WJ
        • Barr JS
        «Rupture of the intervertebral disc with involvement of the spinal canal», August 2, 1934.
        N Engl J Med. 1934; 211: 210-215
        • Jho HD
        Microsurgical anterior cervical foraminotomy for radiculopathy: a new approach to cervical disc herniation.
        J Neurosurg. 1996; 84: 155-160
        • Ware Jr., JE
        • Sherbourne CD
        The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection.
        Med Care. 1992; 30: 473-483
        • Vernon H
        • Mior S.
        The Neck Disability Index: a study of reliability and validity.
        J Manipulative Physiol Ther. 1991; 14 (Sep): 409-415
        • White AA
        • Panjabi MM
        Clinical biomechanics of the spine.
        Second ed. JB Lippincott, Philadelphia1990 (ISBN 0-397-50720-8)
        • R Core Team
        R: a language and environment for statistical computing.
        R Foundation for Statistical Computing, Vienna, Austria2017 (URL Available at:)
        • Carreon LY
        • Glassman SD
        • Campbell MJ
        • Anderson PA.
        Neck Disability Index, short form-36 physical component summary, and pain scales for neck and arm pain: the minimum clinically important difference and substantial clinical benefit after cervical spine fusion.
        Spine J. 2010; 10: 469-474
        • Robinson RA
        • Smith GW
        Anterolateral cervical disc removal and interbody fusion for cervical disc syndrome.
        Bull Johns Hopkins Hosp. 1955; 96 (Abstract): 223-224
        • Verbiest H
        A lateral approach to the cervical spine: technique and indications.
        J Neurosurg. 1968; 28: 191-203
        • Hakuba A
        Trans-unco-discal approach. A combined anterior and lateral approach to cervical discs.
        J Neurosurg. 1976; 45: 284-291
        • Chen TY
        • Crawford NR
        • Sonntag VK
        • et al.
        Biomechanical effects of progressive anterior cervical decompression.
        Spine. 2001; 26: 6-14
        • Hilibrand AS
        • Carlson GD
        • Palumbo MA
        • et al.
        Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis.
        Bone Joint Surg Am. 1999; 81A: 519-528
        • Jho HD
        • Kim WK
        • Kim MH.
        Anterior microforaminotomy for treatment of cervical radiculopathy: part 1—disc-preserving “functional cervical disc surgery”.
        Neurosurgery. 2002; 51 (Nov): S46-S53
        • Kim MH.
        Clinical and radiological long-term outcomes of anterior microforaminotomy for cervical degenerative disease.
        spine. 2013; 38: 1812-1819
        • Pechlivanis I
        • Brenke C
        • Scholz M
        • Engelhardt M
        • Harders A
        • Schmieder K.
        Treatment of degenerative cervical disc disease with uncoforaminotomy–intermediate clinical outcome.
        Minim Invasive Neurosurg. 2008; 51 (Aug): 211-217
        • Park YK
        • Moon HJ
        • Kwon TH
        • Kim JH.
        Long-term outcomes following anterior foraminotomy for one- or two-level cervical radiculopathy.
        Eur Spine J. 2013; 22 (Jul): 1489-1496
        • Choi G
        • Lee SH
        • Bhanot A
        • Chae YS
        • Jung B
        • Lee S.
        Modified transcorporeal anterior cervical microforaminotomy for cervical radiculopathy: a technical note and early results.
        Eur Spine J. 2007; 16 (Sep): 1387-1393
        • Balasubramanian C
        • Price R
        • Brydon H.
        Anterior cervical microforaminotomy for cervical radiculopathy—results and review.
        Minim Invasive Neurosurg. 2008; 51: 258-262
        • Hong WJ
        • Kim WK
        • Park CW
        • Lee SG
        • Yoo CJ
        • Kim YB
        • et al.
        Comparison between transuncal approach and upper vertebral transcorporeal approach for unilateral cervical radiculopathy - a preliminary report.
        Minim Invasive Neurosurg. 2006; 49 (Oct): 296-301
        • White BD
        • Buxton N
        • Fitzgerald JJ.
        Anterior cervical foraminotomy for cervical radiculopathy.
        Br J Neurosurg. 2007; 21 (Aug): 370-374
        • Han C
        • Kim MH.
        Extent of disc degeneration after single-level cervical anterior microforaminotomy analyzed with long-term radiological data.
        J Korean Neurosurg Soc. 2014; 56 (Sep): 200-205
        • Johnson JP
        • Filler AG
        • McBride DQ
        • Batzdorf U.
        Anterior cervical foraminotomy for unilateral radicular disease.
        Spine (Phila Pa 1976). 2000; 25 (Apr 15): 905-909
        • Koç RK
        • Menkü A
        • Tucer B
        • Göçmez C
        • Akdemir H.
        Anterior cervical foraminotomy for unilateral spondylotic radiculopathy.
        Minim Invasive Neurosurg. 2004; 47 (Jun): 186-189
        • Kotil K
        • Bilge T.
        Prospective study of anterior cervical microforaminotomy for cervical radiculopathy.
        J Clin Neurosci. 2008; 15 (Jul): 749-756
        • Lee JY
        • Löhr M
        • Impekoven P
        • Koebke J
        • Ernestus RI
        • Ebel H
        • et al.
        Small keyhole transuncal foraminotomy for unilateral cervical radiculopathy.
        Acta Neurochir (Wien). 2006; 148 (Sep): 951-958
        • Saringer W
        • Nöbauer I
        • Reddy M
        • Tschabitscher M
        • Horaczek A.
        Microsurgical anterior cervical foraminotomy (uncoforaminotomy) for unilateral radiculopathy: clinical results of a new technique.
        Acta Neurochir (Wien). 2002; 144 (Jul): 685-694
        • Hacker RJ
        • Miller GG.
        Failed anterior cervical foraminotomy.
        Neurosurg. 2003; 98: 126-130
        • Jho HD.
        Failed anterior cervical foraminotomy.
        Neurosurg. 2003; 98: 121-125