Whether from injury or simply aging, neck pain is something most of us experience at some point in our lives. While the majority of patients find relief with nonsurgical treatments, such as medication and/or physical therapy, a small number of patients may actually need surgical treatment. This article is about posterior cervical foraminotomy (PCF); a type of neck surgery that is performed to decompress a pinched nerve in your neck and relieve symptoms, such as pain. Instead of having surgery at a hospital, now many patients can undergo minimally invasive PCF in an outpatient setting. There are many potential benefits, including discharge home on surgery day.
Neck pain varies—some people have mild aches and pains—while others experience radiating pain from the neck down an arm and into one (or both) of their hands. Neurologic (nerve-related) symptoms may include feeling weakness, tingling, shooting pain, and numbness. These are signs that potentially indicate one or more spinal nerves in your neck—and/or possibly your spinal cord—are compressed. A herniated disc is a common cause of neural compression.
If you’re experiencing neurologic symptoms associated with a neck problem, and nonoperative therapies are ineffective, your doctor may recommend a spinal decompression surgery, such as minimally invasive posterior cervical foraminotomy. Decompression means the purpose of the procedure is to create more space for the spinal nerves at one or more levels in your neck. PCF removes disc material, osteophytes (ie, bone spurs), and soft tissue causing compression.
The minimally invasive approach to posterior cervical foraminotomy involves a small incision compared to traditional open neck surgery. Minimally invasive spine surgery (MISS) employs smaller instruments, which means the size of the surgical field (known as exposure) is smaller as well. In addition, specially designed surgical instruments allow the surgeon to avoid cutting soft tissues (eg, muscles) in the cervical spine.
MISS procedures are typically safer, quicker, and promote a faster recovery than traditional open spine surgery. Benefits of MISS may include:
Conditions Treated with Minimally Invasive Posterior Cervical Foraminotomy
A herniated disc in the neck is one of the most common conditions warranting a minimally invasive posterior cervical foraminotomy, but this surgery may be recommended to treat different neck problems, including:
What Happens During an Outpatient Minimally Invasive Posterior Cervical Foraminotomy?
General anesthesia is administered, and you are positioned on the operating table face-down on a padded, upside-down U-shaped head rest. Sterile drapes cover your body.
Imaging during surgery (intraoperative images) is accomplished using a lateral C-arm machine to identify the correct surgical cervical level. A C-arm is an advanced type of x-ray machine that is easily manipulated by the surgical team to capture anatomical images during surgery. It is called a “C” arm because the portable machine resembles the letter “C”.
The surgeon makes a small incision in the skin in the neck over the operative level. A combination of sharp and blunt dissection techniques exposure the anatomical structures of the posterior neck. Confirmatory C-arm images are obtained for surgical guidance. An operative microscope is used to magnify and illuminate the surgical field. Tubular retractors are sequentially inserted to separate and hold muscles and soft tissues apart during the foraminotomy.
A high-speed drill is utilized to create a small window between the overlapping facet joints at the back of the spine. The window provides access to the neural foramen; nerve passageways on either side (ie, left, right) of the intervertebral disc. It is through the neural foramen that spinal nerve roots exit the spinal canal.
As illustrated in the picture below, a herniated disc is impinging a spinal nerve in the neural foramen. Furthermore, bone spurs (ie, osteophytes) compress the opposite side. To decompress the nerves, a bone-cutting tool called Kerrison Rongeurs, along with the high-speed drill, remove bone spurs.
From start to finish, a PCF performed in an outpatient setting takes approximately 30 to 45 minutes.
As stated at the onset of this article, if you are a candidate for this procedure to be performed on an outpatient basis, you are discharged home the same day of surgery. Though pain tends to improve significantly within just a few days after surgery, your surgeon may recommend a cervical collar to be worn to help support the neck during the early phase of healing.
Minimally Invasive Posterior Cervical Foraminotomy Considerations
While minimally invasive posterior cervical foraminotomy is well established for treating small or moderate herniated discs and stenosis of up to two levels, patients with cervical kyphosis, severe neck pain, or large herniated discs may be best treated with a traditional open approach. Also, patients with other serious health problems, such as a heart condition, should have their surgery in a hospital as opposed to an outpatient spine clinic in case unexpected treatment for their co-existing medical condition becomes necessary.