Advertisement

Posterior Cervical Foraminotomy

  • Christine Boone
  • Thomas Mroz
  • C. Rory Goodwin
  • Timothy Witham
  • Daniel SciubbaEmail author
Chapter

Abstract

Posterior cervical foraminotomy was first described in the mid-twentieth century as a treatment for symptomatic neural foraminal stenosis. This technique is best used in cases of posterior or lateral compression of the nerve root. Because of its high rate of success in alleviating symptoms and relatively low risk of complications, it is employed frequently. Approximately 50 years after the introduction of the open approach, minimally invasive adaptations of the technique were developed. The open and minimally invasive approaches allow comparable decompression of the nerve root and similar rates of successful symptom improvement. The minimally invasive approach is associated with decreased blood loss, decreased hospital stay, and reduced postoperative muscle spasm and pain. This chapter reviews the indications, surgical planning considerations, optimal positioning, relevant anatomy, and surgical technique for the open and minimally invasive approaches to the posterior cervical foraminotomy. We also address the potential pitfalls of this technique and identify prophylactic measures to prevent them from occurring.

Supplementary material

Supplementary Video 61.1

MROZ posterior cervical_foramenotomy (MPG 16491 kb)

370679_1_En_61_MOESM2_ESM.pptx (45.5 mb)
Supplementary Data 61.2 Sciubba_Final (PPTX 46551 kb)

References

  1. 1.
    Dodwad S-JM, Dodwad S-NM, Prasarn ML, et al. Posterior cervical foraminotomy: indications, technique, and outcomes. Clin Spine Surg. 2016;29:177–85.  https://doi.org/10.1097/BSD.0000000000000384.CrossRefPubMedGoogle Scholar
  2. 2.
    Hiremath GK, Perez-Cruet MJ. Minimally invasive posterior cervical foraminotomy and microdiscectomy. In: Schmidek and sweet operative neurosurgical techniques. Amsterdam: Elsevier; 2012. p. 1771–6.CrossRefGoogle Scholar
  3. 3.
    Rhee JM, Yoon T, Riew KD. Cervical radiculopathy. J Am Acad Orthop Surg. 2007;15:486–94.  https://doi.org/10.5435/00124635-200708000-00005.CrossRefPubMedGoogle Scholar
  4. 4.
    Tong HC, Haig AJ, Yamakawa K. The spurling test and cervical radiculopathy. Spine. 2002;27:156–9.  https://doi.org/10.1097/00007632-200201150-00007.CrossRefPubMedGoogle Scholar
  5. 5.
    Fast A, Parikh S, Marin EL. The shoulder abduction relief sign in cervical radiculopathy. Arch Phys Med Rehabil. 1989;70:402–3.  https://doi.org/10.1007/BF00460797.pdf.CrossRefPubMedGoogle Scholar
  6. 6.
    Boden SD, McCowin PR, Davis DO, et al. Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am. 1990;72:1178–84.CrossRefGoogle Scholar
  7. 7.
    Dyck P. Cervical foraminotomy: indications and technique. In: Watkins III RG, Watkins IV RG, editors. Surgical approaches to the spine. New York, NY: Springer New York; 2015. p. 277–82.Google Scholar
  8. 8.
    Angevine PD, McCormick PC. Posterior approach to cervical degenerative disease. In: Youmans neurological surgery. Amsterdam: Elsevier; 2011. p. 2868–75.CrossRefGoogle Scholar
  9. 9.
    Wang MC, Kreuter W, Wolfla CE, et al. Trends and variations in cervical spine surgery in the United States: medicare beneficiaries, 1992 to 2005. Spine. 2009;34:955–3.  https://doi.org/10.1097/BRS.0b013e31819e2fd5.CrossRefPubMedGoogle Scholar
  10. 10.
    Roh SW, Kim DH, Cardoso AC, Fessler RG. Endoscopic foraminotomy using a microendoscopic discectomy system in cadaveric specimens. Neurosurg Focus. 1998;4:E4.  https://doi.org/10.3171/foc.1998.4.2.5.CrossRefGoogle Scholar
  11. 11.
    Clark J, Abdullah K, Steinmetz M, et al. Minimally invasive versus open cervical foraminotomy: a systematic review. Global Spine J. 2011;1:009–14.  https://doi.org/10.1055/s-0031-1296050.CrossRefGoogle Scholar
  12. 12.
    Williams RW. Microcervical foraminotomy: an alternative posterior technique for intractable radicular pain. In: Watkins III RG, Watkins IV RG, editors. Surgical approaches to the spine. New York, NY: Springer New York; 2015. p. 283–8.Google Scholar
  13. 13.
    Raynor RB. Anterior or posterior approach to the cervical spine: an anatomical and radiographic evaluation and comparison. Neurosurgery. 1983;12:7–13.CrossRefGoogle Scholar
  14. 14.
    Jagannathan J, Sherman JH, Szabo T, et al. The posterior cervical foraminotomy in the treatment of cervical disc/osteophyte disease: a single-surgeon experience with a minimum of 5 years’ clinical and radiographic follow-up. J Neurosurg Spine. 2009;10:347–56.  https://doi.org/10.3171/2008.12.SPINE08576.CrossRefPubMedGoogle Scholar
  15. 15.
    Bydon M, Mathios D, Macki M, et al. Long-term patient outcomes after posterior cervical foraminotomy: an analysis of 151 cases. J Neurosurg Spine. 2014;21:727–31.  https://doi.org/10.3171/2014.7.SPINE131110.CrossRefPubMedGoogle Scholar
  16. 16.
    Clarke MJ, Ecker RD, Krauss WE, et al. Same-segment and adjacent-segment disease following posterior cervical foraminotomy. J Neurosurg Spine. 2007;6:5–9.  https://doi.org/10.3171/spi.2007.6.1.2.CrossRefPubMedGoogle Scholar
  17. 17.
    Çağlar Y, Bozkurt M, Kahilogullari G, et al. Keyhole approach for posterior cervical discectomy: experience on 84 patients. Minim Invasive Neurosurg. 2007;50:7–11.  https://doi.org/10.1055/s-2007-970138.CrossRefPubMedGoogle Scholar
  18. 18.
    Zeidman SM, Ducker TB. Posterior cervical laminoforaminotomy for radiculopathy: review of 172 cases. Neurosurgery. 1993;33:356–62.PubMedGoogle Scholar
  19. 19.
    Skovrlj B, Gologorsky Y, Haque R, et al. Complications, outcomes, and need for fusion after minimally invasive posterior cervical foraminotomy and microdiscectomy. Spine J. 2014;14:2405–11.  https://doi.org/10.1016/j.spinee.2014.01.048.CrossRefPubMedGoogle Scholar
  20. 20.
    Henderson CM, Hennessy RG, Shuey HMJ, Shackelford GE. Posterior-lateral foraminotomy as an exclusive operative technique for cervical radiculopathy: a review of 846 consecutively operated cases. Neurosurgery. 1983;13:504.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Christine Boone
    • 1
  • Thomas Mroz
    • 2
  • C. Rory Goodwin
    • 1
  • Timothy Witham
    • 1
  • Daniel Sciubba
    • 1
    Email author
  1. 1.Department of NeurosurgeryJohns Hopkins School of MedicineBaltimoreUSA
  2. 2.Center for Spine HealthCleveland ClinicClevelandUSA

Personalised recommendations