A cervical foraminotomy is a surgical procedure done at the front or back of the neck in order to relieve pressure on one or more nerves exiting the spine. The operation entails removing a small portion of bone, joint, and any other soft tissue that overlies and compresses the affected spinal nerve. In some cases, a disc that has prolapsed or herniated may also need to be removed, called a microdiscectomy.

Indications for a Cervical Foraminotomy

A variety of problems may warrant performing a procedure such as a cervical foraminotomy. These include the following:

• A prolapsed intervertebral disc
• Pressure on a spinal nerve due to conditions such as cervical spondylosis and foraminal stenosis
• Radiculopathy (pain as a result of nerve compression) involving the arm with or without associated neck pain
• Where conservative measure to manage the signs and symptoms of the mentioned issues, such as oral medications, physical therapy, and nerve sheath injections, have been unsuccessful
• Where there is significant neurological problems or spinal instability causing severe symptoms and signs. The procedure is then the most appropriate first-line treatment for the pathology

Symptoms of Severe Radiculopathy

The symptoms of nerve compression are:

• Pain in the limb innervated by the compressed spinal nerve
• A stiff or aching limb
• Numbness
• Tingling or burning sensation
• Weakness in the affected arm and/or hand

Success Rates for Cervical Foraminotomy

In general, a cervical foraminotomy is a fairly safe and effective form of treatment with little to no known major complications. Minor complications such as localized infection at the surgical site, blood clots in the soft tissue (hematomas), and leakage of straw-colored fluid (seroma) from the wound may occur but these are minor issues which can be managed effectively enough.

The following outcomes have been noted in patients who have received a cervical foraminotomy:

• More than 90 percent of patients do not experience any complications with between 80 and 90 percent obtaining a significant benefit from the surgery. Additionally, this benefit of being pain-free is usually maintained over the long-term
• The symptom that improves the most after surgery is the arm and/or hand pain caused by the nerve compression. Neck pain and headaches may or may not improve and on rare occasion may even get worse
• The next symptom that improves is the weakness in the affected limb and this can take up to weeks or even months to get better. One’s strength may not return completely to normal but there will be functional sparing
• The numbness and/or pins-and-needles sensation may or may not improve after the procedure. The reason for this is because the nerve fibers that are responsible for transmitting sensation are thinner and thus more vulnerable to pressure effects. These issues can take up to 12 months to improve
• Patients who are experiencing severe arm pain, weakness, and or numbness should consult with their primary care doctors so that they can be examined and investigated further in order to rule out a severe problem such as spinal nerve compression