Cervical Foraminotamy

The procedure can be performed as a day stay surgery, but most patients stay in hospital for 1-2 nights. General anesthesia is utilized and the surgery is performed through an incision of 2-4 cm. Much emphasis is placed on performing the surgery through tiny incisions.

Usually a small window is made on one side of a spinous process, at the junction of the lamina and facet joint, through the removal of some bone and ligament to allow visualization of the involved root. Using a high speed drill and microinstruments, once the nerve root affected is identified, the whole out of which the nerve passes is enlarged. This is the foraminotomy (see below):

The nerve root is then gently elevated and if there is a disk bulge this is palpated. If identified, the disk bulge is incised and typically a tiny piece of disk is removed. The whole disk is not removed. The operation is then complete and after placing cortisone over the nerve root, closure is effected, typically, with dissolving sutures for skin. Typically this takes 1-2 hours to perform.The amount of bony removal (in red) is shown below:

Expectations

In uncomplicated cases the likelihood of good/excellent relief of arm pain is 80-90%. Numbness is slow to recovery and may persist. Weakness also may take 6-12 weeks to return to normal. Pins and needles usually starts to improve immediately.

Recovery

After surgery, patients are monitored on the ward overnight. A soft collar is worn for comfort if desired, and typically patients are discharged within 1-2 days. At home, for the first 6 weeks, nothing greater than 5-10 lbs must be lifted and after this a return to normal activities can be effected. The sutures do not require removal and dissolve with time.

Other Points

A posterior cervical foraminotomy is an excellent operation for the patient with arm symptoms secondary to a cervical disk protusion that avoids implantation of foreign devices and spinal fusion. Not all patients are suitable for this operation but those who are generally do very well.