Minimally Invasive Posterior Cervical Discectomy

Cervical disk protrusions, if they compress the nerves in the neck typically cause arm pain. There are a number of operative ways that this can be managed but, if suitable, a posterior cervical foraminotomy is a vastly under-rated operation which avoids some of the shortcomings of other disk operations and yet still has an excellent outcome in terms of symptom relief, in a minimally invasive fashion.

A posterior cervical foraminotomy is a minimally-invasive procedure designed to enlarge to space through which the nerve root exits from the spinal cord (the so-called neural foramen) and at the same time try to remove any piece of disk which is pushing on the nerve. Interestingly, sometimes the foraminotomy alone can alleviate symptoms without a diskectomy being needed. The whole disk is not removed, just the fragment pressing the nerve root. A fusion is not performed and most patients do not require a neck collar after the surgery.

Whether to use an anterior approach, or a posterior approach is determined by the exact location of the disc herniation. Most disc herniations are positioned in front of the spinal cord; completely or partially. The safest way to get at these is from an anterior approach, so as to avoid any manipulation of the spinal cord. Those that present in a lateral location can be removed by a posterior approach.

Lateral disc herniation	Anterior disc herniation

The approach is the same as for a lumbar disc excision. Sequentially larger dilators are used (smaller caliber) to create a passage to the bone over top of the disc herniation. And, through the microscope, a small amount of bone is removed and the boney tunnel through which the nerve passes is widened. Usually small pieces of disc are removed from directly under the nerve.

All of the work is done through a channel that is about 2 cm wide.

The patient is up walking the same day as surgery and home the next day. Post-operative instructions are given, and a follow-up appointment is made for the office for the following week.

Working Channel

The post-operative care and course is the same as for “Anterior Cervical Discectomy”