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  • exercise453
    Member
    Post count: 53

    Hi Doc….Appreciate the site and forum

    Why is a posterior foraminotomy done vs an endoscopic posterior foraminotomy? Is it some difference in the position of the herniation/osteophyte? The first Peyton Manning posterior scar looks like it was not an endoscopic procedure.

    Can these be done at two consecutive levels-symptoms on one/same side ?
    c3-c4…c4-c5

    Can they be done to a “posterior-osteophyte complex without evidence of cord compression and mild narrowing of the spinal canal, bilateral lateral extension resulting in moderate neuroforaminal stenoses”…..but the symptoms are all on one side.

    Even in the case of a posterior central disc with lateral extension can fusion be avoided if symptoms are only on one side?

    Thanks so much

    Donald Corenman, MD, DC
    Moderator
    Post count: 8427

    You have two questions regarding posterior foraminotomy. One is surgical technique and one has to do with indications.

    Foraminotomy is performed for foraminal stenosis, the compression of a nerve root in the foramen from a herniated disc or bone spur. If the source of compression is a herniated disc, this disc fragment must be in the foramen and not under the cord in the front of the canal. If the fragment to too far forward, manipulation of the spinal cord to remove the fragment is necessary which in my opinion, puts the spinal cord at risk for injury.

    If the compression is from a bone spur, there are two potential origins of the compressive spur; the facet or the uncovertebral joint. If the spur originates from the facet, then the foraminotomy will generally be successful as this procedure removes about 1/2 of the medial facet and obliterates this spur. If the spur however originates from the uncovertebral joint (which is more common), the bone spur cannot be removed completely and there are more failures from this procedure in this case. The reason is that the uncovertebral joint is in the anterior half of the spine and this procedure is posteriorly located which limits access to the spur.

    The procedure can be performed open or through a tube. I use the tube but any surgeon who performs this procedure without a tube will most likely have the same results. The endoscope is a small camera attached to the end of a wand. I use a microscope as there is more working room to see the global picture but there is nothing wrong with using an endoscope. Either technique should elicit the same results.

    The key to this procedure is to make sure you have the correct diagnosis. I just saw a patient who had this procedure performed at another institution and had increasing pain after the procedure. The reason was that his pain originated from an arthritic facet and had nothing to do with his foraminal stenosis. Make sure the correct pain generator is identified (see section on diagnostic nerve and facet blocks).

    Dr. Corenman

    exercise453
    Member
    Post count: 53

    There is something else doc, if I may. From a “giving way” (unilateral) during an incline bench press I may have affected every disc to some degree, c4-t1. Other traumas make it a diagnostic nightmare.

    There is a prominent white line running laterally across the spinal cord at c6-7. It is identical in an mri a year and a half ago and again in a recent one. You could not miss it if you were blind.

    Different radiologists do not even mention it and all the cord findings are normal.

    What could it be and is it worrisome?

    Thans again

    Donald Corenman, MD, DC
    Moderator
    Post count: 8427

    The injury when weight lifting could have some consequences but these should be able to be diagnosed appropriately with the appropriate physical examination and testing.

    A white line running across the cord could be a mach line. This is a shadow that can occur from tissue density (the shoulder), a metal artifact (a tooth filling) or something else. The fact that it is there exactly in the same place on every scan is somewhat weird but if not noted by the radiologists, is probably just an artifact.

    Dr. Corenman

    exercise453
    Member
    Post count: 53

    Hi Doctor,

    Assuming symptomatic levels can a foraminotomy be done above a fusion level given the correct indications (c3-4 over c4-5 fusion to avoid a double)?

    Same question c4-5 fusion over a c7-t1 foraminatomy?

    You say there is a return to most activities after a single and sometimes double fusion. Can a golfer return to golf and jerk his head to the left (involved side) hundreds of times a day, week and so on?

    Thanks

    Donald Corenman, MD, DC
    Moderator
    Post count: 8427

    Foraminotomies can be performed at any level in the cervical spine as long as the indications are correct ands there are no contra-indications (degenerative spondylolisthesis, central disc herniation, bone spur originating from anterior uncovertebral joint). The procedure is performed for nerve compression (arm pain) and not for neck pain.

    After a single level ACDF, my patients can go back to the NFL. Even with a three level ACDF, patients can go back to golf. Two levels are the maximum if they are professional golfers. Artificial disc replacement allows more levels to be surgically involved.

    Dr. Corenman

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