title: Anterior approach to disc herniation with modified anterior microforaminotomy at C7-T2: technical note.
abstract: METHODS
  An easy surgical method to reach C7-Th and T1-T2 foraminal disc herniation is described.
  
  
  OBJECTIVE
  To describe a surgical technique that involves an anterior approach to disc herniation with inverted cone-shaped partial minicorpectomy.
  
  
  BACKGROUND
  Anterior approaches to the cervicothoracic junction are difficult in spinal surgery because the operative area is narrow. The manubrium, the clavicles, and the slope of the vertebral bodies obstruct the view of the surgeon. The vascular and neural structures of the superior mediastinum limit the surgical approach. The thoracic duct and recurrent laryngeal nerve present risks for injury, especially with approaches from the right side. Disc herniations at the C7-T2 level are very rare. Posterior approaches at these levels are advocated because radicular symptoms occur more often than myelopathic symptoms, but anterior discectomy and fusion are generally preferred by many spinal surgeons, as these are approaches that are more intuitive.
  
  
  METHODS
  We review the case histories of all of our patients that underwent inverted cone-shaped partial minicorpectomy and fusion at the C7-T2 disc levels between 2000 and 2008. We applied the surgical techniques described in this manuscript.
  
  
  RESULTS
  The mean follow-up duration was 50 months postoperation. Physical examinations were performed and radiographs were taken at the end of the first 6 months postoperative and every 12 months thereafter. No meaningful changes were recorded on either the Visual Analog Scale or the Neck Disability Index. Cervical alignment was unchanged before and after surgery.
  
  
  CONCLUSIONS
  Minicorpectomy technique of C7 or T1 vertebra is an easy and appropriate method for treating foraminal disc herniation between the C7-T1 and T1-T2 levels.
authors: Department of Neurosurgery, VKV American Hospital, Istanbul, Turkey. alifahirozer@gmail.com
authors: Ali Fahir
authors: AF
authors: Ozer
authors: Tuncay
authors: T
authors: Kaner
authors: Mehdi
authors: M
authors: Sasani
authors: Tunc
authors: T
authors: Oktenoglu
authors: Murat
authors: M
authors: Cosar
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D004185:Disability Evaluation; D017586:Diskectomy / Q000379:methods*; D004210:Dissection / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007403:Intervertebral Disc / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology / Q000473:pathology / Q000601:surgery; D019635:Neurosurgical Procedures / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control; D011843:Radiculopathy / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome