What is an Anterior Cervical Foraminotomy
A foraminotomy is a minimally invasive surgical procedure performed to expand the opening in the spinal column where the nerve roots exit the spinal canal. Its purpose is to relieve the pressure resulting from the foraminal stenosis. This is a painful condition caused by a narrowing of the foramen, the opening within each of the spinal bones that allows nerve roots to pass through.
An anterior cervical foraminotomy is performed on the upper spine in the cervical, or neck, region. It frees the affected nerve from pressure and allows it to move again within the spinal column.
About the Anterior Cervical Foraminotomy Procedure:
The patient is given general anesthesia and an incision is made at the front of the neck, typically within a natural skin crease, for access through an anterior approach. A portion of bone is cut or shaved down to open up the passageway of the foramen. If any disc fragments or bone spurs are present, they are removed.
After the surgery, patients are generally required to wear a soft neck collar to limit their head and neck movement. Physical therapy may be recommended for the first several weeks after surgery. The full recovery time is usually between two and three months.
How does Anterior Cervical Foraminotomy help?
The spinal column is a series of vertebrae. In between these bones are discs that provide support to the spine. The spinal cord in the center of the spinal column sends sensory information from the brain to the body and the body to the brain. This occurs through the network of nerves that spread out from the spinal cord and exit the spinal column through a small opening in between vertebrae. This opening is the intervertebral foramen. Sometimes, one or more opening becomes too narrow for the nerve to pass through. Compression on the nerve, when located in the cervical spine (neck), can lead to neck pain and weakness and tingling in the arms and hand. The cervical foraminotomy procedure helps by enlarging the opening so the affected nerve has sufficient room to exit the spinal column normally. Relieving nerve compression should alleviate its associated symptoms.
What are the benefits of Cervical Foraminotomy?
Anterior cervical foraminotomy is a minimally invasive spine surgery that incurs very little disruption to the muscles and tissue in the affected area. Minimally invasive spinal surgeries are associated with shorter operative times, shorter recovery periods, and a faster return to normal activities. During this procedure, the surgeon can directly visualize the nerves to evaluate the level of compression and, through surgery, create and confirm adequate space for the nerve to exit the spine. Cervical foraminotomy differs from spinal fusion in that it preserves the greatest extent of range of motion and flexibility.
How should I prepare for Cervical Foraminotomy?
The doctor may provide specific recommendations for each patient based on their medical history. In general, it is necessary to avoid certain products before undergoing surgery. Patients who smoke must quit at least a few weeks before their procedure. Smoking can significantly impair the healing process and increase the risk of breathing difficulties under anesthesia. It may be necessary to stop taking certain supplements and medications to decrease the risk of bleeding during and after surgery. Examples include aspirin, ibuprofen, and St. John’s Wort. A more comprehensive list can be discussed if needed. Patients who take prescription medications must alert the surgeon so, if needed, the medication can be adjusted before surgery. Finally, as a way to prepare for surgery, patients should consider how they can recover well. It is necessary to arrange for some extra help around the house prior to surgery so, upon arriving home, there is someone to assist with daily needs like meals, getting to and from the bathroom, and ensuring that medication is taken as directed.
How long is recovery?
After anterior cervical foraminotomy, the patient may remain in the hospital overnight so they can be monitored and assisted with movement and medication as needed. When released, patients can expect activity restrictions that foster optimal healing with little to no disruption to the cervical spine. As an example, patients must avoid heavy lifting, repetitive movements, and strenuous or high-impact activities. Patients may also be advised not to drive, since it is necessary to turn the head to observe potential blind spots. To assist with movement restriction and comfort, patients may wear a rigid or soft collar for at least a few weeks after surgery. To facilitate healing, patients should consume a healthy diet with sufficient amounts of lean protein and healthy fats. To manage comfort, patients may take prescription painkillers for a short time, then transition to over-the-counter pain relievers. This switch usually happens within a week to 10 days of surgery. Patients must rest to help the body heal but must also walk around the house every few hours to maintain adequate circulation for healing and the prevention of blood clots in the legs. Most patients can return to work one to two weeks after their cervical surgery, provided that they can drive safely and do not have to perform physically demanding work. By six weeks, it is usually possible to resume all normal activities.
What are the risks?
This procedure is generally considered safe and beneficial for the relief of uncomfortable symptoms of nerve compression. The chance of minor complications is less than 5%. The risk of major complications is only 1 to 2%. The vast majority of patients who undergo anterior cervical foraminotomy come through the procedure without complications. That said, all surgical procedures do carry some degree of risk. For this spine procedure, the risks include:
- Failure to achieve satisfactory symptom relief
- Nerve damage, resulting in pain, numbness, or weakness
- Chronic pain
- Blood clot
During the consultation for cervical foraminotomy, the surgeon discusses all of the risks associated with the procedure and answers questions that can help the patient understand their risks. Ultimately, we wish for every patient to go into their surgery feeling confident that they are in the very best hands.