Abstract
Spinal surgery for degenerative spondylosis is performed more frequently from the anterior approach than the posterior one. Frequency ratio of the anterior to the posterior approaches is 7:3.
Neurosurgeons mostly prefer the decompression from the anterior approach offering better possibility of findings the uncoosteophytes and/or degenerated discs which compress nerve structures. Foraminotomy from the posterior approach is appropriate in patients suffering from multisegmental cervical spondylosis with clinically manifested C8 radiculopathy.
This approach is technically more simple and safe, especially in fat people and subjects with short neck, where there is a high risk of impairment of cervical structures during the exposition of C7/Th1 level. Diagnosis of C8 radiculopathy can sometimes be a problem both clinically and morphologically.
During 2000-2002 years we investigated 11 patients with C8 radiculopathy with multisegmental cervical degenerative spondylosis according to CT a MRI. We performed EMG to confirm a diagnosis of radiculopathy and somatosensory and motor evoked potentials to exclude the compression of afferent and efferent spinal cord pathways.
We also used myelo CT because to further elucidate the findings of the C7/Th1, where we confirmed localized compression of the appropriate nerve root. Immediately after the operation 7 patients had no pain (64 %) and muscle strength returned to normal in 3 patients.
In case of C8 monoradiculopathy with good correlation of clinical, morphological and EMG findings we recommend simple posterior foraminotomy. It excludes the higher risk of damage to the laryngeus recurrens nerve, ductus thoracicus or cupula pleurae at the C7/Th1 level associated with the anterior approach.
In case of further progression of the cervical spondylosis to upper cervical levels, the possibility of the anterior approach uncomplicated by a previous surgery remains open