An operation for a single pinched nerve root in the neck. Through a small opening at the back of the neck, the bone over the trapped nerve is opened and whatever is pressing on it is removed. The disc stays, nothing is fused and no implant is used. It suits compression out to the side, where the nerve leaves the spine.
Cervical Posterior Foraminotomy. Licensed patient-education animation, ViewMedica.
A cervical nerve root leaves the spine through a short bony tunnel called the foramen. When a disc bulges into that tunnel from the side, or an arthritic spur grows into it, the root is squeezed against the wall, and the pain, numbness and weakness are felt down the arm more than in the neck.
A foraminotomy widens the tunnel. Working from behind, a few millimeters of the lamina and the inner edge of the facet joint over the root are removed, and any disc fragment sitting in the tunnel is lifted out. The root is freed where it is trapped, and everything else is left alone.
An ACDF reaches the same root from the front by removing the whole disc and fusing the level. A foraminotomy reaches it from behind and leaves the disc, the motion and the alignment as they were.
Foraminal decompression. Posterior oblique view of a cervical level with the medial facet and laminar edge removed over the exiting nerve root, showing the widened foramen and the root freed from the offending disc fragment or osteophyte.
Cervical radiculopathy where the symptoms are in the arm and the compression is lateral. The pattern is usually clear: pain running from the neck into the shoulder blade and down a particular part of the arm, sometimes with numbness in specific fingers, often worse when the head is tilted toward the painful side.
Most cervical radiculopathy settles without surgery. Time, therapy, medication and where appropriate an injection come first; this operation is for the arm pain that does not settle, or for a root under enough pressure that waiting risks the weakness becoming permanent.
The foramen is out at the side, so an operation aimed at it cannot help a problem in the middle of the canal, or a problem with the alignment or stability of the neck.
A patient whose main complaint is a painful, stiff neck will not be helped by opening a foramen. Where the spinal cord itself is compressed, the operation needed is laminoplasty or a fusion, and where the level has collapsed and needs its height back, that is an ACDF.
Both operations relieve a compressed cervical nerve root and both work well. They differ in what they involve for the patient and in which problems each can reach.
Dr. Zaidi performs both, and ACDF suits a much wider range of problems. For a nerve root trapped out to the side, a foraminotomy gives the same relief without fusing the level. See how the approach is chosen.
Usually done through a tubular retractor, as in tubular discectomy in the lower back. The muscle is spread apart without being stripped from the bone, and the opening is only as wide as the work needs.
The patient is positioned face down with the head supported. Imaging identifies the exact level before the incision, because the target is only a few millimeters across.
A short incision to one side of the midline. Sequential dilators separate the muscle fibers and a tube is docked directly on the junction of lamina and facet over the affected root.
Under magnification, the edge of the lamina and the medial portion of the facet joint are removed to unroof the root. Typically well under half of the joint is removed: enough to free the nerve without loosening the level.
The root is followed out along the foramen. Any disc fragment beneath it is removed and any spur narrowing the tunnel is taken down, until the nerve is loose along its whole course.
The tube is withdrawn and the muscle falls back together. Closure is a few sutures; there is no implant, no graft and no drain in a routine case.
Tubular cervical foraminotomy. Docking the tube on the lamina-facet junction, unroofing the foramen, and the exiting root freed from a disc fragment with the disc space itself untouched.
Only the part of the disc that has escaped into the foramen is removed, and the rest of the disc stays. That is why the level keeps moving and nothing has to be fused.
Figures are general ranges from the surgical literature and cannot be guaranteed for any one person. Arm pain is usually the first thing to settle. Numbness and weakness recover more slowly and depend on how long the root was compressed. A nerve that has been squeezed for a long time can take months to recover and may not recover fully.
This is decided on the MRI, by whether the pressure is out in the foramen or in the middle of the canal. Please bring any imaging you already have.