Procedures
Watkins Medical Centre
Level 8, 225 Wickham Terrace,
Spring Hill QLD, 4000
All appointments
Phone: (07) 3831 7034
Cervical foraminotomy
Foraminotomy in the neck is used to decompress a cervical nerve root that is compressed and causing referred pain into the arm. The reason for the compression can either be a lateral disc herniation or compression by bony spurs from an arthritic cervical facet joint.
The operation usually gives good results for arm pain, though the results are not as good when there is a lot of neck pain associated with the arm pain. Cervical foraminotomy is not an operation for neck pain.
The procedure is performed under general anaesthetic. An incision is made in the midline on the back of the neck. The length of the incision depends on the number of levels that need to be decompressed. The relevant part of the spine is localized under x-ray. A high speed burr (similar to a dental drill) is used to drill out a portion of the cervical facet joint. This, combined with some removal of other ligamentous tissue, exposes the spinal nerve and allows it to be decompressed. If a disc herniation is present and accessible by this route, there is limited access available to remove the disc fragments.
Post operative course
A soft neck collar may be used for comfort though this is not essential. The neck muscles will fatique quickly because they have been bruised from the surgery. The head is quite heavy (about 9kgs) and the main feeling is one of difficulty of holding the head up for long. The soft collar is useful to put on when the neck feels tired, though it can be taken off when the collar begins to irritate the jaw, as it mostly does after awhile. There is a significant amount of post operative wound pain that is usually controlled by a patient controlled analgesia device (PCA). The length of post operative stay depends on the length of time that ongoing strong analgesia is required, though typically this is 2-3 days. Return to light duties at work can usually be achieved at three weeks, with full duties by six weeks.
Risks and Complications
The procedure has a quite low rate of adverse events. The most important are:
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Failure to completely relieve the compression. The most common need to do a foraminotomy is for bony spurs that are compressing the nerve root. Spurs form on arthritic joints. The neck is unusual in that, as well as having a facet joint that can cause spurs to compress the nerve from the back, there is also a joint at the front of the spine (the neurocentral joint) that can compress the nerve at the front. In other words, the nerve is frequently compressed in two directions. Whilst a decompression of one of the directions of compression is usually adequate, this is not always the case and occasionally a further procedure at the front of the spine (anterior cervical fusion) may be needed.
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Infection
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Nerve damage (rare)