Cervical Foraminotomy

A cervical foraminotomy is used to treat nerve root compression, also known as cervical radiculopathy, which can result from various spinal conditions. The most common causes include:

• Herniated Discs: When the soft inner portion of a spinal disc protrudes through its outer layer, it can press on nearby nerve roots, causing pain and neurological symptoms.
• Bone Spurs: As part of degenerative disc disease, bone spurs may form around the foramen, narrowing the space and pinching the nerves.
• Cervical Stenosis: A condition where the spinal canal or neural foramen narrows due to aging, arthritis, or degenerative changes, leading to nerve compression.
• Degenerative Disc Disease: Over time, the intervertebral discs lose hydration and height, which can lead to increased pressure on the nerve roots.
• Facet Joint Hypertrophy: Enlargement of the facet joints due to arthritis or inflammation can encroach upon the neural foramen and compress nerves.

Cervical foraminotomy is typically recommended for patients who experience persistent symptoms of nerve compression that do not respond to non-surgical treatments. These symptoms may include:

• Pain that radiates from the neck into the shoulder, arm, and hand
• Numbness or tingling in the arms or hands
• Muscle weakness in the upper extremities or decreased grip strength

Before considering surgery, Dr. Boden typically recommends a course of conservative treatments, such as physical therapy, anti-inflammatory medications, activity modification, and epidural steroid injections. However, if symptoms persist or worsen despite non-operative treatments and significantly impact daily activities, cervical foraminotomy may be the best option for relief.

Ideal candidates for cervical foraminotomy include patients who:

• Have confirmed nerve root compression on imaging studies such as MRI and CT scans
• Have tried non-surgical treatments for several weeks without significant relief
• Have radicular pain (pain that radiates into the arm) due to foraminal narrowing
• Do not have spinal instability or severe degenerative conditions requiring spinal fusion
• Are in overall good health with no contraindications to surgery

Patients with severe spinal cord compression, multi-level instability, or significant spinal deformity may require more extensive procedures such as posterior cervical laminectomy and fusion or anterior cervical discectomy and fusion instead of a foraminotomy.

Cervical foraminotomy is typically performed using a minimally invasive technique under general anesthesia. Dr. Boden will access the back of the neck through a small incision. She will use specialized instruments to remove a small portion of the bone overlying the compressed nerve to relive the compression.

Once the nerve root is decompressed, the instruments are removed, and the incision is closed with minimal sutures. The procedure is often performed on an outpatient basis, meaning most patients can go home the same day.

Recovery from cervical foraminotomy is faster and less painful compared to traditional cervical spine surgery due to the minimally invasive approach. However, patients should follow post-operative guidelines carefully to ensure optimal healing.

Full recovery generally takes 6 to 8 weeks. Patients who follow rehabilitation guidelines often experience significant symptom relief and improved arm function. Long-term outcomes are excellent as there is no fusion involved and foraminotomy does not change the biomechanics of natural neck motion. Most patients experiencelasting pain relief and functional improvement. Avoiding repetitive strain, maintaining proper ergonomics, and regular exercise can help prevent recurrence of symptoms.