What is the extent of spinal decompression advised prior to completion of a cervical osteotomy

The entire posterior arch of C7 with the inferior portion of C6 and the superior portion of T1 is removed. The eighth cervical nerve roots are identified at the C7-T1 neuroforamen and are widely decompressed through the lateral recess, removing the overlying bone at the foramen (Fig. 69-6). The cervical pedicles need to be undercut with Kerrison rongeurs to allow ample room for the eighth cervical nerve roots when the osteotomy site is closed. The amount of bone to be resected is carefully assessed preoperatively and intraoperatively to avoid compression of the nerve roots during closure of the osteotomy. The residual portions of the laminae of C6 and T1 must be carefully beveled and undercut to avoid any impingement or kinking of the spinal cord on closure of the osteotomy site.

Figure 69-6. Outline of area of bony resection for a cervical osteotomy. The lines of resection of the laterally fused facet joints are beveled slightly away from each other, extending posteriorly so that the two surfaces will be parallel and in apposition following correction. The pedicles must be undercut to avoid impingement on the C8 nerve roots. The midline resection is beveled on its deep surface above and below to avoid impingement against the dura following extension correction. (From Simmons ED Jr, Simmons EH. Ankylosing spondylitis. Spine State Art Rev 1994;8:589-604, with permission.)

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