Cervical Posterior Foraminotomy
What is Cervical Posterior Foraminotomy?
Cervical posterior foraminotomy is a surgical procedure performed to treat foraminal stenosis, a condition in which the openings for nerve roots to exit the spinal canal have become too small, resulting in painful nerve compression. These openings, called foramen, may have gradually become clogged by herniated discs, calcified ligaments or joints, or bone spurs. Whatever the cause, once the foramen are narrowed, the pressure of bone against the cervical nerves may cause pain, numbness, weakness or tingling sensations.
Some patients with foraminal stenosis can be effectively treated with anti-inflammatory medications, corticosteroid shots, physical therapy exercises or a neck brace to immobilize the spine. When the condition does not respond to these conservative treatments, however, surgery may be required. The cervical posterior foraminotomy will eliminate the compression on the affected spinal nerve, providing relief from painful symptoms. As its name suggests, a cervical posterior foraminotomy is performed on the spine in the neck area with the surgeon making an approach through the upper back.
Am I a Candidate for a Cervical Foraminotomy?
When a patient has foraminal stenosis, narrowing of the openings for the nerve roots to exit the spinal canal, Dr. Girardi exhausts conservative treatment options prior to moving to surgery. In these cases, patients can often be effectively treated with anti-inflammatory medications, corticosteroid injections, physical therapy, or by using a neck brace to immobilize the spine.
There are cases when early surgery is recommended, however. If the nerve compression is severe and causing extreme weakness in the arm, early surgery may be necessary. The same is true if the arm pain is so severe that it isn’t responding to available pain medication.
When a herniated disc is the cause of the compression, a cervical foraminotomy may not be the best operation. Instead a microdiscectomy is a better procedure. When the focus is on removing part of the bone to provide more room for the nerve root, a foraminotomy is called for. But there can be overlap between the procedures when it comes to dealing with a protruding cervical disc. Surgery usually becomes a viable option when conservative treatments have not made improvements after six weeks.
Non-Surgical Treatment Options
While cervical foraminotomy is a successful procedure in the majority of cases, most patients can get better without surgery. These are conservative treatments that will be tried first:
- Analgesia with NSAIDs
- Analgesia with other medications
- Perineural steroid and local anesthetic injections
The Cervical Foraminotomy Procedure
A cervical posterior foraminotomy is performed with the patient under general anesthesia. With the patient lying face down on the operating table, the surgeon makes an incision in the back of the neck. Muscles, ligaments and other tissues in the area are retracted to provide a view of the spine. The bone at the affected site is shaved down or cut back slightly to enlarge the size of the foramen and provide more room for the nerve roots to pass through.
The surgeon assesses the spine to see whether any other nearby structures are exerting pressure on the nerves. A portion of the lamina, the covering of the vertebrae, disc fragments, thickened tissue, or bone spurs are removed as necessary. For some patients, a spinal fusion is required to for greater stability. Once the procedure is completed, the surgeon repositions the muscles and other tissues and sutures the incision. A cervical posterior foraminotomy typically lasts for approximately 2 hours.
What type of anesthesia is used in a cervical foraminotomy?
Dr. Girardi performs minimally invasive cervical foraminotomy whenever possible. This allows this procedure to be done on an outpatient basis. Still, the patient needs to be under general anesthesia.
What happens after my surgery?
The procedure is usually performed on an outpatient basis, with the patient released from the hospital later the same day. The patient will have to wear a soft neck collar temporarily to restrict movement of the head and neck until healing has taken place. Typically, a regimen of physical therapy is prescribed to help the patient regain strength and flexibility in the cervical region. While some physical activities may be prohibited until healing is complete, most patients can return to work in about 4 weeks.
The likelihood of a good/excellent outcome for this procedure is from 85-90 percent. In roughly 10 percent of cases, the procedure doesn’t fully relieve the arm pain. Numbness from the compression is slow to fully resolve, and it may persist. If you’ve had arm weakness, it can take from 6-12 weeks to return to normal. The tingling/pins and needles feeling in your arm and hands usually resolves immediately with this surgery.
Risks of Cervical Foraminotomy
Complications are rare during a cervical posterior foraminotomy, but there are risks inherent to any type of surgical procedure. The risks associated with a cervical posterior foraminotomy include blood loss, infection, nerve damage, blood clots and an adverse reaction to anesthesia or medication. There is also some small risk that the pain from the stenosis will persist after surgery.
At a Glance
Dr. Federico Girardi MD
- Triple fellowship-trained spinal surgeon
- Performs over 400 spinal surgeries per year
- Professor of orthopedic surgery at Cornell University
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