Home > Procedures > Spinal Surgery > Cervical Foraminotomy

Foraminotomy is a surgery that expands the area around one of the bones in the spinal cord. A cervical foraminotomy describes on which part of the spine the surgery is performed. Here you will find information on this particular type of surgery including how it is performed and expected patient outcomes.

Cervical foraminotomy surgery is performed at the back of the neck to release any pinching or pressure exerted on one or more spinal nerves. It includes removing bone spurs, also called osteophytes which put pressure on the spinal nerve and also any soft tissues such as ligaments or scars that may also be causing continuous pressure.

Why is it performed? What is it used to treat?

Various processes can compress the nerve leaving the spinal cord and block the intervertebral foramen. Following are some of the conditions that can cause this nerve compression:

  • Spondylosis that can cause bony spurs
  • Degenerative arthritis of the spine
  • The disintegration of the intervertebral discs, that can lead them to protrude into the foramen
  • Enlargement of the nearby ligament
  • Tumours or cysts
  • Spondylolisthesis
  • Paget disease
  • Congenital problems such as dwarfism

Nerve compression can cause symptoms such as weakness and tingling sensation in the affected limb, and severe pain in the affected part of the spine. A cervical foraminotomy may be advised when the patient experiencing these symptoms has had no relief from other treatment options. These can include epidural injections, physical therapies, and pain medications.

How is foraminotomy performed?

The surgical procedure is performed under the effect of general anaesthesia. An endotracheal tube or breathing tube will be inserted. Some antibiotics and steroids are injected intravenously to prevent post-surgery nausea and infection. To reduce the risk of developing blood clots in the patient’s legs, calf compression devices are used throughout the procedure. After the skin is properly cleaned, a local anaesthetic is injected. 

The surgeon will make a vertical and midline incision of around 3 to 5 cm at the back of the patient’s neck. After separating the muscles from the spinal bones, the bony part and any soft tissue overlying and compressing the nerve is removed. This part of the surgery is done under a microscope with the help of fine instruments and small drills to ensure precision. The incision is carefully closed with staples or sutures. 

The foraminotomy procedure takes around one to two hours to complete. The relieving of the spinal nerve from any pressures is known as rhizolysis.

How to prepare for surgery 

In preparation for surgery, the patient is advised to: 

  • Avoid drinking or eating at least 8 hours before the surgery
  • Avoid using any hair gels and hair sprays
  • Wear comfortable and loose-fitting clothes for the surgery
  • Avoid consuming any blood-thinning, anti-inflammatory medicines, and any herbal supplements at least 1 week before the surgery

Recovering from surgery

The patient will experience some level of discomfort immediately after the procedure is complete. Later on, there are chances that the patient will experience some muscle spasms and neck pain. This will resolve gradually in a few days or weeks.  

Patients are usually free of the nerve pain soon after surgery. There may be a need to complete specific exercises or physiotherapy. This will address symptoms of neck pain and any limb muscle weakness that may have occurred due to the nerve compression. 

Side effects, risks, and possible complications

Some possible complications include:

  • Infection
  • Nerve damage
  • Blood loss
  • Damage to the spinal cord
  • Stroke
  • Complications from anaesthesia like nausea, confusion, vomiting

Success rates of foraminotomy

Around 80-90% of patients obtain a substantial benefit from foraminotomy surgery. The results stay long-term.

Frequently asked questions

What is the difference between a foraminotomy and a laminectomy?

Foraminotomy is the removal of bone around the neural foramen which is a canal where the nerve roots exit the spine. Laminectomy is the removal of the complete bony lamina, a part of the enlarged facet joints, and the thickened ligaments overlying the spinal cord and associated nerves.

What is the difference between foraminotomy and an anterior cervical discectomy?

Cervical foraminotomy has comparable efficacy and effectiveness as anterior cervical discectomy. However, a foraminotomy has less surgery time, lower costs and faster recovery time as compared to the anterior cervical discectomy. Foraminotomy is done through the posterior route. It does not need replacement with any implants unlike the anterior cervical discectomy.

Does a cervical foraminotomy weaken the spine?

The procedure doesn’t weaken the spine in any way. Only a very small part of the bone is removed to relive the pressure over the compressed nerve causing the symptoms.

Does a cervical foraminotomy require screws and rods to be placed on the spine?

No screws or rods are placed on the spine after the cervical foraminotomy procedure.