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Posterior Foraminotomy

What is Posterior Cervical Foraminotomy?

Posterior cervical foraminotomy is a surgical procedure performed through the back of the neck to relieve symptoms of a pinched or compressed spinal nerve by enlarging the neural foramen, an opening for the nerve roots to exit the spine and travel through the body, and creating more space for the spinal nerve to pass through. The neural foramen forms a protective passageway for nerves to transmit signals from the spinal cord to the rest of the body.

Posterior cervical foraminotomy can be performed through a minimally invasive approach, which does not require cutting and stripping of the muscles from the spine region, unlike the conventional open spine surgery that requires spine muscles to be cut or stripped.

Cervical Spine Anatomy

The spine is made up of 33 small bones called vertebrae and is known as the spinal column or vertebral column. It can be divided into 5 parts: cervical, thoracic, lumbar, sacral, and coccyx region. The cervical spine is comprised of the first 7 vertebrae (C1-C7), which support the neck and the head.  The vertebrae are protected by spongy vertebral discs present between them and supported by ligaments that hold them together and surround the underlying spinal cord.

Indications for Posterior Cervical Foraminotomy

Conditions such as herniated discs, bone spurs, and thickened ligaments or joints can narrow the neural foramen and pinch the spinal nerves. A pinched or compressed nerve in the neck region can cause neck pain, stiffness and/or pain, tingling sensation, and numbness or weakness that radiates down the arm and hand. If you fail to show improvement with non-surgical therapy, your doctor may suggest posterior cervical foraminotomy.

Preparation for Posterior Cervical Foraminotomy

During your assessment, you must inform your doctor about any health conditions you may have such as diabetes or bleeding disorders, and about any medications that you may be taking, such as blood thinners and over-the-counter medications. You may be asked to stop taking certain medicines for several days before the procedure.

Your doctor will explain the surgical procedure, its risks and benefits, and answer all your other surgery-related queries before the procedure. A medical health clearance is required from your physician for the surgery. Blood tests, X-rays or other imaging tests may also be ordered to assess your medical condition.

Procedure for Posterior Cervical Foraminotomy

The procedure is performed in the back of the neck under anaesthesia with you lying face down. Your surgeon makes a small incision on the symptomatic side of your neck and approaches the spine by separating the neck muscles apart using a retractor. Then, the bone or disc material and/or the thickened ligaments are removed, relieving the pressure on spinal nerve structures, creating decompression. The neck muscles are brought back into their original position by removing the retractor. After the procedure, your surgeon closes the incision using sutures.

Postoperative Care

After surgery, the pain symptoms may improve immediately or gradually over the course of time. Most patients are able to go home 1 to 2 days after surgery. Before patients go home, physical therapists and occupational therapists work with patients and instruct them on proper techniques of getting in and out of bed and walking independently. You will need to limit your activities to avoid strain on the healing vertebrae for the first 1 to 2 weeks. Physical therapy will be initiated gradually to improve your neck strength and flexibility. You will be able to resume your daily activities within a few weeks. Compliance with your surgeon’s postoperative instructions, such as activity modifications, diet, incision site care, bathing, driving, pain medications, and scheduled follow-up appointments will provide better results.

Risks and Complications of Posterior Cervical Foraminotomy

As with any surgical procedure, posterior cervical foraminotomy involves potential risks and complications that may include:

  • Damage to spinal cord or nerve root
  • Anaesthetic problems
  • Neck stiffness
  • Incomplete relief of symptoms
  • Repeat disc herniation
  • Bleeding
  • Infection