Cervical Foraminotomy

Cervical Foraminotomy is a surgical procedure to enlarge the neural foramina in the neck region. Cervical neural foramina are cavities in the cervical vertebrae which act as transits for the spinal nerves in the neck. Each cervical vertebra has two neural foramina, one on either side. Cervical foraminotomy is indicated in patients with excruciating arm pain due to radiculopathy (compression of the spinal nerves).

Degenerative changes in the spine result from ageing or repetitive use. These changes can damage the intervertebral disc resulting in a collapse of the disc which reduces the distance between the adjacent vertebrae and also constricts the neural foramina. Bone spurs (osteophytes), herniated disc or thickened ligaments further constrict the foramina and exert pressure over the spinal nerves passing through them, resulting in arm pain and numbness.

Procedure

The procedure is performed under general anesthesia. The patient lies face down on the operating table and the head is fixed in position with a special device called Mayfield. A vertical incision is made over the neck, in the mid-line. The neck muscles are retracted and the segment of the cervical spine where the spinal nerves are compressed is exposed for surgery. Disc fragments or bone spurs around the neural foramen are then removed using small cutting instruments. During the surgery, a microscope is generally used to improve the view of the surgical site. The muscles and soft tissues are then repositioned and the incision is sutured.

Patients are usually discharged in a day or two after the surgery. The pain in the arm is significantly reduced after the procedure. However, arm numbness may take some time to resolve following the surgery.

After the surgery

Slight pain around the incision site and spasms of the neck muscles are common and usually resolve within a week of the surgery. The incision should always be kept clean and dry. The bandaged area should be covered properly to prevent it from getting wet, especially while bathing. Patients are advised to avoid lifting, bending or twisting of the neck for four to six weeks after the surgery. The patient may be advised to wear a neck brace. The patient may resume work, with some restrictions, as early as two to four weeks after the surgery.

Risks and complications

The risks associated with cervical foraminotomy are low but may include infection, bleeding, nerve damage and leakage of spinal fluid.

Herniation of another disc may occur, in the same segment, after the procedure.