Open laminoforaminotomy: A lost art?

BACKGROUND

Open cervical laminoforaminotomy (CLF) provides safe and effective decompression/excision of lateral/foraminal disc herniations/spurs contributing to nerve root compression. CLF's advantages over anterior cervical discectomy/fusion (ACDF) include the lack of risk to anterior structures (esophagus, trachea, carotid, and recurrent laryngeal nerve) and the avoidance of a fusion. Further, advantages over minimally invasive surgery CLF (MIS CLF) include a lower incidence of dural tears, infections, and neural injury. Furthermore, complications are now more often reported in medicolegal suits rather than the spinal surgical literature.

METHODS

Here, in a select review of the spinal literature in which we specifically focused on the benefits, risks, and complication of open CLF versus the various MIS CLS techniques.

RESULTS

Open CLF is a unique posterior cervical surgical technique that is technically demanding. When using an MIS CLF approach that provides limited visualization and maneuverability while incurring greater morbidity (e.g., risks more dural tears, infection, and neural damage).

CONCLUSIONS

Why not utilize open CLF, adequately and safely, to decompress lateral/foraminally compromised cervical nerve roots, and avoid the risks of MIS CLF or ACDF? Presently, too many spine surgeons automatically choose MIS CLF or ACDF over open CLF; is this because it is a "lost art"?