What is Cervical Foraminotomy?
In my prior blogs, we discussed cervical radiculopathy, or in simple terms, a pinched nerve in the neck. Usually, there is associated pain, numbness and tingling corresponding to the distribution of the pinched nerves functions. As we discussed before, these nerves can have a distribution of sensation called dermatomes, as well as corresponding associated reflexes, and set groups of muscles.
Causes of the pinching of the nerve are usually from disk herniations, and bone spurs. Unfortunately, but rarely, it can be caused my more serious problems such as fractures, infections and tumors. In general, however, most episodes of cervical radiculopathy usually resolve with non-surgical means. But for a certain percentage of patients, surgery will become the only treatment that will give relief.
Cervical Foraminotomy is one of the options that can provide surgical relief in that patient population.
In the most simple explanation, Cervical Foraminotomy means removing the bone spurs that cause the pinching of the nerve. The incision is made from the back of the neck, and the bone spurs from the arthritic facet joints are partially removed.
Cervical Foraminotomy can also be combined with removing of a disc herniation that is located in an accessible location in the spine. The surgical judgement call involves determining which cervical disc herniations can be approached through the opening created by the cervical foraminotomy. If the disc herniation is located too far to the middle of the spine, it requires retraction on the spinal cord to properly remove the disk fragment. The key is to minimize any pressure on the spinal cord during removal of the disc. If the location of the disc necessitates excessive spinal cord retraction to retrieve the disk, the better approach may be to remove the disc from the front. That procedure is the Anterior Cervical Discectomy and Fusion surgery.
Sometimes, even with posterior Cervical Foraminotomy, there remains residual bone spurs, but with improvement of the space for the nerve, there is still favorable reduction of the pain.
While performing Cervical Foraminotomy, the surgeon must assess the facet joints of the neck to see if there is stability of the joint. If the joint is not stable, and allows excessive motion, this can also lead to nerve pinching. Also, if certain instances, more bone than orginally planned must be removed, with a high risk of developing instability. In those scenarios, a Posterior Cervical Fusion may also be performed at the time of the surgery, or at a later staged time.
For properly selected patients, with isolated nerve entrapment from posterior bone spurs, Cervical Foraminotomy is an excellent option.
- Mai HT, Chun DS, Schneider AD, Hecht AC, Maroon JC, Hsu WK. The Difference in Clinical Outcomes After Anterior Cervical Fusion, Disk Replacement, and Foraminotomy in Professional Athletes. Clin Spine Surg. 2017 Jul 17; PubMed PMID: 28719454
- Peto I, Scheiwe C, Kogias E, Hubbe U. Minimally Invasive Posterior Cervical Foraminotomy: Freiburg Experience With 34 Patients. Clin Spine Surg. 2017 Feb 23; PubMed PMID: 28234772
Last modified: January 5, 2018