Fryckholm (Posterior decompression and nucleotomy)
What is it?
Fryckholm’s technique was developed to treat cervical radiculopathy, particularly in cases where soft disc herniations or spondylotic changes caused nerve root compression. This technique of posterior decompression and nucleotomy represents a significant milestone in the evolution of cervical spine surgery because it offers a motion-preserving option for selected cases of cervical radiculopathy, particularly where direct decompression of the nerve root is required and underscores the importance of tailored surgical approaches based on individual patient pathology and the continuous evolution of spinal surgical methods.
One of the primary advantages of Fryckholm’s technique is preserving intervertebral disc and overall spinal stability, as it avoids extensive discectomy and fusion. This particularly benefits patients with isolated nerve root compression without significant disc degeneration or instability.
However, this technique has limitations, especially in large disc herniations or multilevel spondylosis, where anterior approaches may be more effective.
Patients undergoing Fryckholm’s procedure generally experience significant relief from radicular symptoms.
Procedure
Fryckholm’s technique involves a posterior approach to the cervical spine. Unlike anterior approaches, which directly address disc pathology, this posterior method focuses on decompressing the affected nerve root by removing the offending structures from a dorsal perspective.
The procedure begins with a midline incision over the relevant cervical segments. Subperiosteal dissection exposes the laminae and facet joints. A key aspect of Fryckholm’s technique is the partial removal of the lamina (laminotomy) and the medial aspect of the facet joint to access the nerve root canal.
Once the nerve root is visualized, the surgeon performs a careful dissection to identify and remove any compressive lesions, such as herniated disc material or osteophytes. Nucleotomy, the removal of disc material, is performed as needed, taking care not to destabilize the adjacent vertebral segments. This includes microsurgical techniques for enhanced precision and minimal invasiveness and incorporating intraoperative imaging and neuromonitoring for improved safety and efficacy.