Posterior Cervical Foraminotomy

A posterior cervical foraminotomy is a small surgery performed using a microscope to remove a disc herniation or bone spur that is pushing on a nerve root and causing arm or neck pain. Only the herniated piece of the disc is removed and the remainder of the disc is saved.

The most common reason to have surgery is to alleviate pain that has not resolved within a reasonable time period. Many people would like to be more active than their pain allows and this usually persuades them to have surgery.

If your pain is mild or moderately tolerable we do not recommend you proceed with surgery. We also feel that numbness, tingling, or the loss of a reflex is not sufficient to indicate surgery is absolutely necessary. Muscle weakness, especially if worsening, is a good reason to consider operative intervention.

Foraminotomy is quite effective in relieving pain radiating down the arm, however, it is not particularly effective in relieving neck pain. Most times an anterior cervical discectomy must be performed to adequately relieve pressure on the nerve or spinal cord. However, in disc herniations that are lateral, or to the side of the spinal cord, a posterior cervical foraminotomy may be an option.

During surgery, you are carefully positioned face down using a head holder. A small incision is made over the back of your neck, at the level of the ruptured disc or bone spur. The muscles are dissected over to the side to allow us to look at the back part of your vertebrae called the lamina. A small amount of bone is trimmed from the lamina to create a space between the two vertebrae. Utilizing a microscope, the nerve is visualized and then pulled toward the middle part of the spine. Under a microscope, we then look very carefully underneath the nerve root to pull any free fragments or discs. In many situations, in which there is only bony impingement, we do not have to look at the disc; we simply remove the area of the bone spurs.

The most common complication is failure to relieve all pain. A spinal fluid leak occurs in about 1% of cases and can require hospitalization to allow time to heal.

Nerve injury resulting in weakness in part of the arm or hand occurs in 1–2% of cases. The chance of paralysis is extremely low. Infection occurs in 1–2% of cases. Wrong-level surgery can occur but chances of this are minimized by use of live x-ray during the surgery to locate the proper disc.

A posterior cervical foraminotomy is about 80% successful in relieving pain in the arms. Pain relief is typically quite rapid, although it may take six to eight weeks for the nerve to calm down in specific instances. If a nerve has been pinched for a long time, the success rate is rarely 100% as there is usually some residual mild tingling, weakness, or pain, all of which are fairly tolerable.

Our overall advice for this type of surgery is the same for any other spine surgery, which is to live with the pain you are experiencing if you can. The reason for undergoing the operation is that the pain or weakness is making life so uncomfortable or difficult that you are willing to accept the chance of a result that is less than 100% successful.

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