Posterior Cervical Foraminotomy

For patients whose pain does not improve with non surgical treatments, surgery may be necessary. Depending on the location of the herniated disc, the surgeon may make an incision either in the front or back of your neck to reach the spine. The technical decision of whether to perform the operation from the front of the neck (anterior approach) or the back of the neck (posterior approach) is influenced by many factors including the exact location of the disc herniation and the experience and preference of the surgeon. With either approach, the disc material is removed from the nerve, usually with good results.


While an anterior cervical discectomy is the most common treatment for disc herniation, a posterior (back) cervical approach can be performed to alleviate nerve pinching. A laminotomy (partial removal of the lamina) and foraminotomy (opening of the foramen where the nerve exists) can be done for disc herniation if the herniation pinches the nerve root or if there is pressure on the nerve from overgrowth of bone (a bone spur or osteophyte). This procedure cannot be used to effectively remove the compression of the spinal nerve or spinal cord caused by a midline disc herniation.


GENERAL PROCEDURE

1. Surgical approach

The skin incision is made on the back of the neck.

The muscles are dissected off of the spine.

Deep retractors are placed.

2. Bone removal

After the correct disc space has been identified on x-ray, a keyhole is made in the lamina and part of the facet is removed.

The pressure on the nerve caused by bony overgrowth is removed.

The nerve may be retracted and the disc removed. The dissection is often performed using an operating microscope.

Advantage of Foraminotomy vs. Anterior Cervical Discectomy

Foraminotomy does not require fusion

Allows for treatment of serveral spinal motion segments (multilevel foraminotomy)

Disadvantage of Foraminotomy vs. Anterior Cervical Discectomy

Increased incidence of neck pain with foraminotomy over anterior cervical discectomy

Cannot decompress a central disc herniation with foraminotomy

AFTER SURGERY

Patients will feel some pain after surgery, especially at the incision site. While tingling sensations or numbness is common, and should lessen over time, they should be reported to the doctor. Most patients are encouraged to be up and moving around within a few hours after surgery. After surgery, your doctor will give you instructions on when you can resume your normal daily activities.

Signs of infection like swelling, redness or draining at the incision site, and fever should be checked out by the surgeon immediately. Keep in mind, the amount of time it takes to return to normal activities is different for every patient. Discomfort should decrease a little each day. Most patients will benefit from a postoperative exercise program or supervised physical therapy after surgery. You should ask your doctor about exercises to help with recovery.


OUTCOME

The results of the surgery are variable since some people have more extensive disease than others. In general, after the surgery most patients can expect to regain:

Some spinal cord function

Improvement in their hand function and walking/balancing capabilities

Surgery is very effective in reducing the pain in the arms and shoulders caused by nerve compression. However, some neck pain may persist.

Decrease numbness in the hands (if there was a lot of numbness prior to the surgery, it probably won’t go away completely)

POSSIBLE RISKS/COMPLICATIONS

Possible risks and complications of posterior foraminotomy may include:

3-5% recurrent radiculopathy from foraminotomy

1-3% neurologic injury rate

Damage to the spinal cord (about 1 in 10,000)

Bleeding

<1% infection rate

Continued neck pain or arm pain

Muscle scarring and atrophy

Recurrent disc hernia

tion

Death

There is chance of a recurrent disc herniation because most of the disc is not removed with this type of surgery.