Posterior Cervical Foraminotomy Overview
The posterior cervical foraminotomy procedure that is designed to remove a herniated disc from the rear of the neck (the cervical spine). There are significant restrictions regarding this procedure as it has a limited usefulness.
A patient needs to have a good understanding of the anatomy of the neck to understand when this procedure is useful. The hole that the neck nerve exits out of is called the foramen. The foramen has a front wall, two side walls and a back wall. The front wall is made up of the disc and uncovertebral joint (please see section on anatomy for further explanation). The two side walls are the pedicle above and below. The rear wall is the facet. Of course, the facet is made of two joining bony surfaces, the superior and inferior facet from the vertebra above and below.
The posterior cervical foraminotomy name nicely describes what the surgery entails. The surgery is performed from the back of the neck (posterior cervical) and the foramen is partially removed (foraminotomy). If the procedure was called a foraminectomy, the entire foramen would be removed (ectomy vs. otomy).
The facet is obviously where the approach to this surgery is made as it is the back wall of the foramen and the surface that presents during posterior surgery. A small incision is made in the back of the neck at the level of the herniation. After the incision is made, a small tube can be placed to operate through or a small retractor can be used to expose the facet.
Using a small burr, a portion of the inside of the facet is removed- normally about one-half of the facet. This exposes the back of the nerve root and the blood vessels in the foramen. Using small instruments, the nerve is gently moved up or down to free up the herniated disc fragments. Once removed, the procedure is over and the incision is closed.