Tagged: ACDF or posterior foraminotomy
aprokopParticipantOctober 8, 2020 at 8:44 amPost count: 18
My MRI reading stated that C3-C4 had Disc Osteophyte complex and uncinate spurring causing severe right and moderate to severe left neural foraminal narrowing. Mild spinal canal narrowing.
My surgeon recommended that I get a Posterior Cervical Foraminotomy. Do you agree that this would be a good option? Can a level that is severe heal on its own? What can I expect with this surgery? Is it a easier recovery than a ACDF? I have had symptoms for 3 years now. All my symptoms are on the right side. Which include: headaches, upper trap pain, pain in the shoulder and loss of ROM. I can’t not swing a golf club or throw a baseball without pain. I had a ACDF on my C5/C6 and was told that level healed fine and had a solid fusion by at least 3 different surgeons.
I can manage the pain with reduced activity and lots of Tylenol and advil etc. However I would like to be pain free and able to do the activities I once did. My biggest concern is that the Posterior Foraminotomy would make things worse and leed to my 3 neck surgery.
AndrewDonald Corenman, MD, DCModeratorOctober 8, 2020 at 11:08 amPost count: 8468
It is my opinion that compression originating from the front (“Disc Osteophyte complex and uncinate spurring”) should be removed from the front to directly decompress the nerve root. This would require an ACDF (anterior decompression and fusion). A posterior foraminotomy enlarges the exit hole (foramen) but does not remove the spur that is compressing the nerve root. This procedure can still work but is less effective than the ACDF.
The problem in your case is with a prior ACDF at C5-6, this would leave the C4-5 level between two fusion levels and this could prematurely wear this level out. In your case, a posterior foraminotomy might be OK as if this procedure does not yield relief, you can always go back and do the ACDF. However, you could also consider an artificial disc replacement at C3-4 which might help preserve the C4-5 level.
I would first however consider a diagnostic block of the right C3-4 level (SNRB-see https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic-neck/). This would confirm that this problem is your pain generator.
Dr. CorenmanaprokopParticipantOctober 19, 2020 at 7:29 amPost count: 18
Is a Posterior Foraminotomy as painful as a PCDF? I hear that Posterior Fusion are very painful. I was wondering if the Posterior Foraminotomy is just as painful and difficult to recover from?Donald Corenman, MD, DCModeratorOctober 20, 2020 at 4:30 amPost count: 8468
Is a Posterior Foraminotomy as painful as a PCDF (posterior cervical decompression and fusion)? No.
The posterior route is more uncomfortable than the anterior route (ACDF) but generally a foraminotomy is much less uncomfortable than a posterior fusion. Also the ACDF heals in 6-8 weeks generally while the PCDF heals in 3-4 months.
Dr. CorenmanaprokopParticipantFebruary 8, 2021 at 12:53 pmPost count: 18
How long will I be out of work if I do the Foraminotomy? I am a teacher. How long before I can return to normal activities? Have any of your patients regretted having this surgery?Donald Corenman, MD, DCModeratorFebruary 14, 2021 at 12:02 pmPost count: 8468
Being a teacher with no significant physical duties (gym teacher or such), you could be back to work in 1-2 weeks wearing a collar when you are with students.In the appropriately selected patients, the satisfaction rate should be 90%.
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