Posterior Cervical Foraminotomy

Overview

Posterior cervical foraminotomy is a minimally invasive procedure that relieves nerve compression in the cervical spine through a small incision in the back of the neck. Unlike ACDF, which requires fusion, foraminotomy preserves natural motion by removing only the bone and soft tissue compressing the nerve — without fusing the vertebrae. Dr. Basques uses a tubular retractor system to make an incision of approximately 1.5–2 cm. Under the surgical microscope, he removes the portion of the facet joint and any bone spur or disc fragment compressing the nerve root as it exits the spinal canal. This procedure is ideal for patients with a lateral disc herniation or foraminal stenosis at one or two levels who want to avoid fusion. Dr. Basques is highly experienced in this targeted, motion-sparing technique.

How It Works

Under general anesthesia, the patient is positioned face-down. Using intraoperative X-ray, Dr. Basques precisely locates the affected level. A small incision (1.5–2 cm) is made in the back of the neck, slightly off the midline on the affected side. Tubular dilators create a working channel through the paraspinal muscles. Under the operating microscope, Dr. Basques identifies the facet joint and the compressed nerve root. A high-speed burr and fine instruments are used to remove a small portion of the facet joint (foraminotomy) along with any disc fragment or bone spur compressing the nerve. Once the nerve is free and decompressed, the instruments and retractors are removed. The incision is closed with one or two stitches. Most procedures take 45–75 minutes.

Benefits

Who Is a Candidate?

Ideal candidates have a lateral cervical disc herniation or foraminal stenosis causing arm pain, numbness, or weakness that has not responded to 6–8 weeks of non-surgical treatment. Candidates must have symptoms affecting a nerve root (radiculopathy) — not the spinal cord (myelopathy). Patients who want to preserve neck motion and avoid fusion are strong candidates. The procedure is best suited for one or two levels. Dr. Basques evaluates MRIs to confirm the compression is lateral (in the foramen) rather than central.

Recovery & Aftercare

Most patients go home the same day or after one night of observation. Mild neck soreness resolves within days. Light activities resume within 1 week. Return to desk work is typically 1–2 weeks. No heavy lifting or strenuous activity for 4–6 weeks. Because there is no fusion, there are no long-term activity restrictions once healed. Physical therapy may be recommended for range-of-motion and strengthening exercises.

Related Procedures