Posterior Cervical Endoscopic Foraminotomy

What it is and why we do it

A pinched nerve in the neck (cervical radiculopathy) causes pain, tingling, or weakness that travels into the shoulder, arm, or hand. The nerve is usually pinched where it leaves the spine, by a soft disc fragment or a bone spur in the nerve tunnel, the foramen. Most people get better without surgery. When they do not, there are three ways to free the nerve: a fusion from the front, a disc replacement from the front, or a foraminotomy from the back.

A posterior foraminotomy enlarges the nerve tunnel from behind by trimming a few millimeters of bone and removing the fragment or spur. Nothing is fused and nothing is implanted. The disc stays, the neck keeps its motion, and the front of the neck, with the throat and voice box, is never touched. Done with an endoscope, the incision is about 1 centimeter and the neck muscles are spread rather than cut.

Who it suits

The best candidates have arm symptoms from one nerve, on one side, caused by a fragment or spur sitting toward the side of the canal, with a neck that is stable and reasonably well aligned. It is not the right operation for pressure on the spinal cord itself (myelopathy), a large central herniation, an unstable or kyphotic neck, or a bony ridge along the whole back of the disc. For those, a front approach is better, and I will say so.

What happens during surgery

Under general anesthesia, lying face down with the head supported, X-ray guides a tube to the junction of the two laminae at the level of the pinched nerve. The endoscope shows the bone, the edge of the facet joint, and the nerve. A small burr removes the inner edge of the joint and the lamina, exposing the nerve, and the fragment or spur under it is removed. Nerve monitoring runs throughout. One level usually takes under an hour. The incision is closed with a stitch and a strip of tape.

Your recovery

Most people go home the same day. The arm pain is usually much better at once. There is some neck and shoulder-blade soreness for a week or two, treated with acetaminophen and short-term stronger medicine if needed. No collar is needed, though a soft one for comfort in the car is fine for a few days. Desk work often restarts in one to two weeks. Numbness and weakness recover over weeks to months, in that order. See my playbook after neck surgery.

Activity and restrictions

Walk from the first day. For four weeks, no lifting over 10 pounds, no overhead work, and no sports. Driving once you are off opioids and can check your mirrors comfortably. Gentle range of motion for the neck from the first week; physical therapy for posture and the deep neck muscles at about four weeks. Full activity after the six-week visit.

The science: for the curious

Published series of endoscopic cervical foraminotomy report good or excellent relief of arm symptoms in about nine of ten patients, with low complication rates and reoperation rates around one in twenty. Because the disc is left in place, there is a small chance the same level will pinch again in the future, and because no fusion is made, there is no added stress on the neighboring levels, the main long-term worry with fusion. The foraminotomy has been done with a microscope for decades; the endoscope shrinks the incision and the muscle injury without changing what is done inside.

Learn more

OrthoInfo, Cervical Radiculopathy, Surgical Treatment Options: orthoinfo.aaos.org (opens in a new tab)

My overview of endoscopic spine surgery compares every endoscopic procedure I offer, and my guide to cervical disc replacement covers the front-of-the-neck alternative.

Watch

Posterior cervical endoscopic foraminotomy2:54

This handout is general education about this procedure and does not replace the specific plan, risks, and consent discussion we have together. Your own situation may differ: if anything here does not match what we talked about, what we talked about wins, so please ask me.