Posterior cervical foraminotomy is a good option for people who have a herniated disc or a bone spur in their cervical spine (neck) that is pressing on the nerve root and causing symptoms. Symptoms may include neck pain, numbness, tingling, and/or weakness in an arm. Posterior cervical foraminotomy may be appropriate for those who have spinal stenosis, degenerative disc disease, and/or bone spurs that press on the nerve roots.
A posterior cervical foraminotomy is performed under general anesthesia. You will be placed face down on a special operating table with an opening for your face (much like a massage table, only sturdier). Your surgical team will use a special X-ray machine called fluoroscopy to take a short X-ray movie of your cervical spine. This will allow your spine surgeon to accurately make a small incision in the back of your neck, just to one side of your spine.
In minimally invasive posterior cervical foraminotomy, small devices are used to gently move overlying tissues and reveal the spine. Your spine surgeon then uses a high-speed drill to make a window in between the lamina bones of the cervical spine.
Once a small is made in the facet(s), the spine surgeon can then visualize inside the affected spinal level through a surgical microscope. At this point, the spine surgeon may do any number of things to expand the foramina, which is the tunnel through which the nerve root passes through the spinal bones. The spine surgeon will remove any bone spurs at that level and remove all disc material that is likely causing symptoms.
Once the nerve roots (and possible nerves and spinal cord) have been decompressed, the devices that held the area open are removed, and the skin is closed with self-dissolving sutures. The surgical incision is covered with a small bandage, and you are transferred to a post-anesthesia care unit. After you have fully recovered from the anesthesia, you will be discharged home. You will not be able to drive after general anesthesia, so make sure to arrange transportation. The posterior cervical foraminotomy itself usually takes less than an hour, and the whole process only requires about three to four hours in most cases.
Recovering from posterior cervical foraminotomy is usually much faster and less challenging that recovering from artificial disc replacement or fusion. You will almost certainly not need to wear a neck brace, only a soft cervical collar. Because the minimally invasive posterior cervical foraminotomy incision and the surgical field are small, there is usually very little blood loss and only mild to moderate pain during recovery. While opioid medications may be prescribed, milder analgesics like acetaminophen and muscle relaxants are generally able to control the discomfort.
Nevertheless, you will be required to limit your activity a bit after posterior cervical foraminotomy until the neck and back muscles recover. While you should follow your spine surgeon’s specific instructions, most patients should avoid extreme bending or turning the neck and driving for at least the first week after the procedure. Lifting anything greater than ten pounds should be avoided for at least two weeks after posterior cervical foraminotomy and perhaps longer.
You will have appointments with your physical therapist and spine surgeon within the first two weeks of posterior cervical foraminotomy recovery. At that time, these professionals will help you determine when you may resume certain activities.
You may shower (not bathe) as soon as you feel ready, but keep the incision dry for the first several days of recovery. As soon as you are finished with the shower, remove the bandage, gently dry the wound, and place a clean bandage. Since the surgical wound is on the back of your neck, it is best to have someone help you with dressing changes.
Posterior cervical foraminotomy is quite successful for most patients. Studies show that about nine out of 10 people have less pain and fewer symptoms after posterior cervical foraminotomy. Arm pain may be significantly better within a few days of the spine surgery. Neck pain may or may not improve with surgery, though more patients report neck pain relief after posterior cervical foraminotomy than those who do not. Muscle weakness improves a little more slowly, generally taking several weeks to recover. Arm numbness may or may not recover after posterior cervical foraminotomy. Numbness may take up to 12 months to go away. If numbness does not resolve within the first year after posterior cervical foraminotomy, it is likely permanent. That being said, patient satisfaction rates after posterior cervical foraminotomy are greater than 80%.
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