The Efficacy of Using an Image-Guided Kerrison Punch in Performing an Anterior Cervical Foraminotomy

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Abstract
This study comprised two parts: first, a feasibility study to determine the efficacy of using an image-guided Kerrison punch while performing a foraminotomy during an anterior cervical decompression and, second, an anatomic analysis using vector measurement to determine the distance from the entrance of the neuroforamen to the medial margin of the vertebral artery in the subaxial cervical spine. To assess the feasibility of using an image-guided Kerrison punch when performing an anterior foraminotomy and to obtain data regarding the distance from the vertebral artery to the entrance of the neuroforamen. The documented incidence of catastrophic iatrogenic vertebral artery injury in anterior cervical decompression is low. The use of a real-time image-guidance surgical system should reduce the risk of this complication. Twelve cadaveric cervical spines were harvested. Standard anterior cervical discectomies with bilateral foraminotomies were performed in the subaxial cervical spine using an image-guided Kerrison. Surgically significant morphometric data were measured using a computer-assisted image-guided surgical system. Successful navigation into all neuroforamina in the subaxial cervical spine was attained using the image-guided Kerrison punch. The vector measurement from the neuroforamen to the vertebral artery averaged 5.8 ± 1.2 mm at C3–C4, 6.5 ± 1.6 mm at C4–C5, 7.9 ± 1.4 mm at C5–C6, and 9.1 ± 1.8 mm at C6–C7. Statistically significant differences (P < 0.05) were found between all cervical levels except C3–C4 and C4–C5. An image-guided Kerrison punch may be used successfully when performing cervical foraminotomies during an anterior cervical discectomy, thus eliminating the risk of potential vertebral artery injury. These data confirm previous findings by other authors. Knowledge of these data may aid the spine surgeon in performing a foraminotomy during anterior cervical decompression.