Minimally Invasive Cervical Foraminotomy and Decompression of Stenosis

  • John E. O’Toole
  • Kurt M. Eichholz
  • Richard G. Fessler


Many types of degenerative cervical spine disease can be treated with well-established posterior decompressive procedures.14 Even as anterior cervical procedures have gained prominence, posterior cervical laminoforaminotomy still provides symptomatic relief in 92–97% of patients with radiculopathy from foraminal stenosis or lateral herniated discs.3, 5 Similarly, posterior cervical decompression for cervical stenosis achieves neurological improvement in 62.5–83% of myelopathic patients undergoing either laminectomy or laminoplasty.4, 68 Moreover, these operations avoid the complications attendant to anterior approaches to the cervical spine, namely, esophageal injury, vascular injury, recurrent laryngeal nerve paralysis, dysphagia, and accelerated degeneration of adjacent motion segments after fusion.911

However, open posterior approaches to the cervical spine require extensive subperiosteal stripping of the paraspinal musculature that leads to postoperative pain, spasm, and dysfunction and can be persistently disabling in 18–60% of patients.4, 9, 12, 13 Furthermore, preoperative loss of lordosis combined with long-segment decompression increases the risk for postoperative sagittal plane deformity,1417 a complication that frequently prompts instrumented arthrodesis at the time of laminectomy. Employing these extensive posterior fusion techniques increases operative time, surgical risks, and blood loss; exacerbates early postoperative pain; and potentially contributes to adjacent level degeneration.


Neck Disability Index Ligamentum Flavum Recurrent Laryngeal Nerve Paralysis Foraminal Stenosis Ulnar Neuropathy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Aldrich F. Posterolateral microdisectomy for cervical monoradiculopathy caused by posterolateral soft cervical disc sequestration. J Neurosurg. 1990;72(3):370–377CrossRefPubMedGoogle Scholar
  2. 2.
    Crandall PH, Batzdorf U. Cervical spondylotic myelopathy. J Neurosurg. 1966;25(1):57–66CrossRefPubMedGoogle Scholar
  3. 3.
    Henderson CM, Hennessy RG, Shuey HM Jr, Shackelford EG. Posterior-lateral foraminotomy as an exclusive operative technique for cervical radiculopathy: a review of 846 consecutively operated cases. Neurosurgery. 1983;13(5):504–512CrossRefPubMedGoogle Scholar
  4. 4.
    Ratliff JK, Cooper PR. Cervical laminoplasty: a critical review. J Neurosurg. 2003;98(3 Suppl):230–238PubMedGoogle Scholar
  5. 5.
    Khoo LT, Perez-Cruet MJ, Laich DT, Fessler RG. Posterior cervical microendoscopic foraminotomy. In: Perez-Cruet MJ, Fessler RG (eds). Outpatient Spinal Surgery. St. Louis: Quality Medical Publishing, Inc., 2006, pp. 71–93Google Scholar
  6. 6.
    Kumar VG, Rea GL, Mervis LJ, McGregor JM. Cervical spondylotic myelopathy: functional and radiographic long-term outcome after laminectomy and posterior fusion. Neurosurgery. 1999;44(4):771–777; discussion 777–778CrossRefPubMedGoogle Scholar
  7. 7.
    Wang MY, Green BA. Laminoplasty for the treatment of failed anterior cervical spine surgery. Neurosurg Focus. 15 2003;15(3):E7Google Scholar
  8. 8.
    Wang MY, Shah S, Green BA. Clinical outcomes following cervical laminoplasty for 204 patients with cervical spondylotic myelopathy. Surg Neurol. 2004;62(6):487–492; discussion 492–483CrossRefPubMedGoogle Scholar
  9. 9.
    Fessler RG, Khoo LT. Minimally invasive cervical microendoscopic foraminotomy: an initial clinical experience. Neurosurgery. 2002;51(5 Suppl):S37–S45PubMedGoogle Scholar
  10. 10.
    Hilibrand AS, Robbins M. Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? Spine J. 2004;4(6 Suppl):190S–194SCrossRefGoogle Scholar
  11. 11.
    Ishihara H, Kanamori M, Kawaguchi Y, Nakamura H, Kimura T. Adjacent segment disease after anterior cervical interbody fusion. Spine J. 2004;4(6):624–628CrossRefPubMedGoogle Scholar
  12. 12.
    Hosono N, Yonenobu K, Ono K. Neck and shoulder pain after laminoplasty. A noticeable complication. Spine. 1996;21(17):1969–1973CrossRefPubMedGoogle Scholar
  13. 13.
    Siddiqui A, Yonemura KS. Posterior cervical microendoscopic diskectomy and laminoforaminotomy. In: Kim DH, Fessler RG, Regan JJ (eds). Endoscopic Spine Surgery and Instrumentation: Percutaneous Procedures. New York: Thieme, 2005, pp. 66–73Google Scholar
  14. 14.
    Albert TJ, Vacarro A. Postlaminectomy kyphosis. Spine. 1998;23(24):2738–2745CrossRefPubMedGoogle Scholar
  15. 15.
    Kaptain GJ, Simmons NE, Replogle RE, Pobereskin L. Incidence and outcome of kyphotic deformity following laminectomy for cervical spondylotic myelopathy. J Neurosurg. 2000;93(2 Suppl):199–204PubMedGoogle Scholar
  16. 16.
    Perez-Cruet MJ, Samartzis D, Fessler RG. Microendoscopic cervical laminectomy. In: Perez-Cruet MJ, Khoo LT, Fessler RG (eds). An Anatomic Approach to Minimally Invasive Spine Surgery. St. Louis: Quality Medical Publishing, Inc., 2006, pp. 16-11–16-17Google Scholar
  17. 17.
    Yonenobu K, Okada K, Fuji T, Fujiwara K, Yamashita K, Ono K. Causes of neurologic deterioration following surgical treatment of cervical myelopathy. Spine. 1986;11(8):818–823CrossRefPubMedGoogle Scholar
  18. 18.
    Khoo LT, Bresnahan L, Fessler RG. Cervical endoscopic foraminotomy. In: Fessler RG, Sekhar L (eds). Atlas of Neurosurgical Techniques: Spine and Peripheral Nerves, vol. 1. New York: Thieme, 2006, pp. 785–792Google Scholar
  19. 19.
    Burke TG, Caputy A. Microendoscopic posterior cervical foraminotomy: a cadaveric model and clinical application for cervical radiculopathy. J Neurosurg. 2000;93(1 Suppl):126–129PubMedGoogle Scholar
  20. 20.
    Roh SW, Kim DH, Cardoso AC, Fessler RG. Endoscopic foraminotomy using MED system in cadaveric specimens. Spine. 2000;25(2):260–264CrossRefPubMedGoogle Scholar
  21. 21.
    Adamson TE. Microendoscopic posterior cervical laminoforaminotomy for unilateral radiculopathy: results of a new technique in 100 cases. J Neurosurg. 2001;95(1 Suppl):51–57PubMedGoogle Scholar
  22. 22.
    Perez-Cruet MJ, Wang MY, Samartzis D. Microendoscopic cervical laminectomy and laminoplasty. In: Kim DH, Fessler RG, Regan JJ (eds). Endoscopic Spine Surgery and Instrumentation: Percutaneous Procedures. New York: Thieme, 2005, pp. 74–87Google Scholar
  23. 23.
    Wang MY, Green BA, Coscarella E, Baskaya MK, Levi AD, Guest JD. Minimally invasive cervical expansile laminoplasty: an initial cadaveric study. Neurosurgery. 2003;52(2):370–373; discussion 373CrossRefPubMedGoogle Scholar
  24. 24.
    Khoo LT, Fessler RG. Microendoscopic decompressive laminotomy for the treatment of lumbar stenosis. Neurosurgery. 2002;51(5 Suppl):S146–S154PubMedGoogle Scholar
  25. 25.
    Yabuki S, Kikuchi S. Endoscopic partial laminectomy for cervical myelopathy. J Neurosurg Spine. 2005;2(2):170–174CrossRefPubMedGoogle Scholar
  26. 26.
    Raynor RB, Pugh J, Shapiro I. Cervical facetectomy and its effect on spine strength. J Neurosurg. 1985;63(2):278–282CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • John E. O’Toole
    • 1
  • Kurt M. Eichholz
    • 1
  • Richard G. Fessler
    • 1
  1. 1.Department of NeurosurgeryRush University Medical CenterChicagoUSA

Personalised recommendations