Posterior Cervical Microforaminotomy/Discectomy

Posterior cervical microforaminotomy/discectomy is an operative procedure that relieves pressure or compression on the nerve roots at the cervical spine.

The cervical region (neck area) forms the upper portion of the spine. A series of cervical vertebrae, C1-C7 connects the cervical spine to the skull. The massive nerve supply to the head, neck, and upper portions of the shoulders and arms is by the spinal nerve roots that branch out from the cervical spine.  Nerves exit spinal cord through an opening called foramen- a tunnel or space through which a spinal nerve exits the spine. Herniation of disc (disc damage) or spinal stenosis (narrowing of spinal canal) can narrow the foramen, and pinches or compresses the nerve structures in the neck region leading to pain, weakness and limited movement in the hands and arms.

Posterior cervical microforaminotomy/discectomy involves making an incision in the back side of the neck (posterior cervical spine) followed by the removal of disc material and/or a part of the bone that compresses nerve roots.

Indications:

Posterior Cervical Microforaminotomy is indicated in patients who experience:

• Neck, shoulder or lower arm pain due to compression in the cervical region
• Swollen or bulging discs
• Bone damage caused by trauma, or conditions like arthritis or osteoporosis.
• Throbbing pain that radiates to the fingers, hands, and lower portion of the arm
• Weakness and restricted range of motion or movement of the neck
• Various spinal disorders that cause foraminal narrowing include degenerative disc diseases, spinal stenosis, and spondylosis.

Types of cervical microforaminotomy/discectomy:

The two different types of microforaminotomy/discectomy commonly performed are:

• Anterior cervical microforaminotomy/discectomy
• Posterior cervical microforaminotomy/discectomy

Posterior cervical microforaminotomy/discectomy surgical procedure:

The goal of posterior cervical microforaminotomy/discectomy is to relieve pressure on the spinal cord and/or nerve roots. The decompression is achieved by expanding the foramen or removing the portion of the intervertebral disc (broken or bulged) that exerts pressure on the spinal nerves and causes pain.

It is a type of minimally invasive spine surgery that involves use of highly specialized small surgical instruments and very small incisions to reduce injury to the surrounding structures.

Method of surgery

Posterior cervical microforaminotomy/discectomy surgery is done from the back (posterior side) of the neck. In this technique, the patient lies face down on the operating table. A small incision is done along the back of the neck. The muscle which lies behind the spine is cut and the affected part of the spine bone is exposed. Miniature surgical instruments are inserted through the incision and expose the compressed nerve or herniated disc. A small amount of bone surrounding the nerve root is carefully removed. This is called microforaminotomy. Any bulging or herniated portion of the disc will be removed, if it continues to bulge against the nerve root, which is known as microdiscectomy. After the nerve root is decompressed, the muscles are re-approximated and the incision is closed with sutures.

Advantages over the traditional open cervical spine surgery:

Some of the benefits of posterior cervical microforaminotomy/discectomy include:

• Very small incisions
• Total surgery time is minimal
• Minimal damage to the surrounding structures
• Shorter recovery time with less post-surgical complications
• Lower rate of infection
• Greater range of motion with less post-operative pain

Post-operative care:

Following are the post-surgical guidelines to be followed after the surgery:

• Make sure you get plenty of rest
• Take medications and antibiotics to help alleviate pain and inflammation as prescribed by your doctor
• Avoid neck bending or straining activities
• Absolutely no driving for about 2 weeks or while taking pain medicines
• Braces such as a soft cervical collar may be advised to wear after surgery to reduce the pain and stress on the neck
• Start rehabilitation (physiotherapy) as recommended by your spine surgeon
• Return to work and sports once the neck has regained normal strength and function

Risks & complications:

With any procedure, some amount of risk will always coexist. Likewise, posterior cervical microforaminotomy/discectomy has complications such as

• Bleeding or infection
• Unrelieved neck pain
• Damage to spinal cord, nerves, and blood vessels
• Spine may lose its stability
• Need for additional surgery due to occurrence of above complications.

Discuss with your spine surgeon if you have any concerns or queries regarding posterior cervical microforaminotomy/discectomy.