Total Uncinatectomy Revisited: Revision Surgery for Persistent Radiculopathy Following Anterior Cervical Discectomy and Fusion (ACDF)

Wan Kee Hong; Sung Shik Kang; Dong Bong Lee; Ho-Joong Kim; Jemin Yi; Hyeon Guk Cho; Bong-Soon Chang; Choon-Ki Lee; Jin S. Yeom

doi:10.4055/jkoa.2014.49.5.394

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Hong, Kang, Lee, Kim, Yi, Cho, Chang, Lee, and Yeom: Total Uncinatectomy Revisited: Revision Surgery for Persistent Radiculopathy Following Anterior Cervical Discectomy and Fusion (ACDF)

Case Report

Journal of the Korean Orthopaedic Association 2014; 49(5): 394-399.

Published online: 30 October 2014

DOI: https://doi.org/10.4055/jkoa.2014.49.5.394

Total Uncinatectomy Revisited: Revision Surgery for Persistent Radiculopathy Following Anterior Cervical Discectomy and Fusion (ACDF)

Wan Kee Hong, B.A., Sung Shik Kang, M.D.^*, Dong Bong Lee, M.D., Ho-Joong Kim, M.D., Jemin Yi, M.D., Hyeon Guk Cho, M.D., Bong-Soon Chang, M.D.^†, Choon-Ki Lee, M.D.^†, Jin S. Yeom, M.D.

Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.

^*Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea.

^†Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea.

Correspondence to: Sung Shik Kang, M.D. Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 626-770, Korea. TEL: +82-55-360-2125, FAX: +82-55-360-2155, osdockang@gmail.com

Received 2 March 2014 Revised 23 April 2014 Accepted 27 April 2014

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We report on a case involving total en bloc uncinatectomy of C7 without removal of the previously inserted cage, performed on a patient with a history of previous anterior cervical discectomy and fusion without uncoforaminotomy at C5-6-7 who had persistent pain radiating to the upper extremity along with progressive weakness. Satisfactory results were achieved. This procedure should be regarded as an effective option for surgical treatment of persistent or recurrent radiculopathy caused by remaining foraminal stenosis following anterior cervical fusion, and we suggest it as a new indication for this procedure.

Keywords: uncinate process, uncovertebral joint, radiculopathy, total uncinatectomy, anterior cervical discectomy and fusion

Figures and Tables

Figure 1

Lateral radiographs taken in flexion (A) and extension (B) at 14 months after the initial operation are shown. The difference in interspinous distances at C5-6 was 2.5 mm, suggesting nonunion at this level.

Figure 2

Computed tomography scan images are shown. (A) A left foraminal oblique image shows nonunion at C5-6 (black arrowhead) and large foraminal spurs at C6-7 (white arrowhead). (B) An axial image shows a large foraminal spur from the left uncinate process of C7 (black arrowhead).

Figure 3

T2-weighted magnetic resonance images show a large foraminal spur (white arrowhead) from the left uncinate process of C7 (A), spinal cord compression between the herniated disc and slightly buckled ligamentum flavum at C4-5 (B, C), and cord signal change at C5-6 (C).

Figure 4

Left foraminal oblique (A), axial (B), and 3-dimensional computed tomography (C) scan images taken 2 days after the revision surgery show complete resection of the left C7 uncinate spur (arrowheads) and satisfactory decompression.

Figure 5

Lateral radiographs taken in flexion (A) and extension (B) at 12 months after the revision surgery show solid fusion of the 3 surgical levels with difference in interspinous distances of less than 1 mm at each level.

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