Endoscopic Cervical Foraminotomy – Posterior approach

Cervical hernia and neck injuries leading to compressed or ruptured discs and prolapsed discs in the Cervical can be as a result of the ageing process. However, increasing numbers of cases are being treated for lifestyle problems as a result of repetitive stress injuries that left untreated or uncorrected over decades has resulted in the neck and cervical deformities that have pinched a nerve or a blood vessel.

The effects of pinched nerves in the cervical spinal section are blackouts, radial pain extending across to the chest in some cases and weakening and reduction in mobility of the neck muscles.

Foraminotomy as the name suggests relieves the spinal root nerves compression by creating more room in the foramen which is the hole in the cervical vertebrae through which the spinal column passes. When the disc matter compresses the spine and nerves on one side, this is called unilateral compression and the surgeon can increase the hole to make the nerves pass through without any compression. When disc matter intrudes, a portion of the vertebrae can be removed to make more room for the spine and the nerves. Since this is minimally invasive there is usually no requirement to fuse vertebrae for stability.

The procedure is performed in the back of the neck, which means that the patient will be lying face down on the operating table. General anesthesia is administered and the patient will feel nothing during the procedure. A one to two inch incision is made by the surgeon who then will proceed to dissect away the section of the soft tissue that is causing the impediment to the nerves under magnification. Very precise instruments help in removal of a small amount of bone on the outer wall of the foramen thereby exposing the spine. In cases of disc prolapse the nerve root is gently lifted and the intruding portion of the discs are removed. In cases that warrant lesser intrusion the entire procedure is done through a tube which requires even lesser invasion.

Symptomatic relief is seen in 85- 90% of cases. Some patients may require a short course of post-operative physical therapy.