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Cervical Posterior Foraminotomy
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A posterior cervical foraminotomy is a minimally-invasive procedure created to expand the space through which a nerve root exits from the spinal cord, and also try to remove any piece of disk which is putting pressure on the nerve. Sometimes, a foraminotomy alone can lighten the symptoms without a discectomy being needed. Just the fragment pressing the nerve root is removed and not the whole disk. A fusion needs not be performed and most patients usually do not require a neck collar post the surgery.
This procedure eases pressure on spinal nerve root by creating more room for it to pass through the foramen. When the disc material squeezes the nerve root on one side, the cervical foraminotomy can be used to remove the portion of the problem disc. When a bone spur narrows the foramen and compresses the nerve root, a posterior cervical foraminotomy carve the spur to widen the passageway. This procedure is also referred to as a minimally invasive surgery, in which an incision is relatively small and no fusion of the spine is required.
A posterior cervical foraminotomy is performed in the back of the neck, which means that the patient will be lying on this stomach on the operating table. He/she will be kept under general anesthesia so that he feels nothing during the procedure. The spine surgeon will make a small skin incision of 1 to 2 inches, he/she will cut apart the soft tissue on the side of the compression. Precision equipment is used to carefully remove a small amount of bone which serves as the outer wall of the foramen. Once the foramen is opened, the nerve root becomes visible. In cases where the disc material causes compression, the nerve root is gently lifted and the disc material removed. The wound is then closed, and the patient is provided with a soft collar.
Another adaptation of this technique is an extremely minimally invasive procedure where the surgeon may make a smaller skin incision and use a tubular retractor to access the spine. Regardless of the approach, standard skin incision or with minimally invasive tubes, posterior cervical foraminotomy promises relief of nerve root compression with minimal bone removal. Nearly 85- 90% of cases conclude with symptomatic relief from pain. Some patients may require a short course of post-operative physical therapy. Risks caused due to this procedure are uncommon but include infection, bleeding, neck stiffness, repeat disc herniation, incomplete relief from symptoms, damage to nerve root or spinal cord, or problems with anesthesia.
Most patients can go home after 1-2 days of the surgery. Before patients go home, physical and occupational therapists work with them and instruct them on proper techniques of getting in and out of bed and walking independently. Patients are advised to avoid excessive bending and twisting of the neck during the immediate post-operative period i.e. first 1-2 weeks. Patients can gradually begin to bend and twist their neck after 2-3 weeks, as the pain gradually subsides and the neck and back muscles get stronger. Patients are also instructed to avoid heavy lifting during the early period.
Most patients do not need to wear a neck brace after the surgery, however, most of them are issued a soft cervical collar. This reduces the stress on the neck area and helps decrease pain in the early postoperative period.
The wound area can be left open to air. No bandages are required. Small surgical tapes fastening the suture should be left in place. The area should be kept clean and dry.
Patients can shower immediately after the surgery, but only keeping the incision area covered with a bandage and tape, and avoid the water from hitting directly over the surgical area. After the shower, they should remove the bandage, and dry off the surgical area. Patients should not take a bath until the wound has completely healed, which is usually around 2 weeks after surgery.
Patients may begin driving when the pain has come down to a mild level, which usually is between 2-7 days after surgery. Patients should not drive while taking pain medicines. When driving for the first time after surgery, patients should make it a short drive only and have someone come with them, in case the pain flares up and they need help driving back home. After patients feel comfortable with a short drive, they can begin driving longer distances alone.
Return to Work and Sports
Patients may return to light work activities as early as 1-2 weeks after the surgery, depending on when the surgical pain has subsided. Patients may return to moderate level work and light recreational sports activities as early as 1 month after the surgery, only if the surgical pain has decreased and the neck strength has returned with physical therapy.
Doctor's Visits and Follow-Up
Patients will need to return for follow-up visit for the doctor to examine the condition approximately 8-10 days after the surgery. The incision will be inspected. There is one suture that will be removed. Medications will be refilled as per necessities. Patients will be given a prescription to begin physical therapy for gentle neck exercises.
Results and Outcome Studies
The results of posterior cervical foraminotomy surgery in the treatment of cervical herniated nucleus pulposus and foraminal stenosis are commonly excellent. Numerous research studies in medical journals demonstrate greater than 84-95% good or excellent results. Most patients have shown a significant, rapid improvement of their radicular arm pain and return to many, if not all, of their normal daily and recreational activities.