Posterior Cervical Foraminotomy is a surgical procedure aimed at relieving pressure on the spinal nerves in the neck (cervical spine) by widening the foramen, the openings through which the nerves exit the spinal column. This procedure is often performed to treat conditions like cervical radiculopathy, where a herniated disc, bone spurs, or other degenerative changes compress the spinal nerves, causing pain, numbness, or weakness in the arms.

Why Choose Posterior Cervical Foraminotomy?

Posterior Cervical Foraminotomy is typically chosen when conservative treatments such as physical therapy, medications, or injections have not provided sufficient relief. This procedure is less invasive than other spinal surgeries and preserves the stability and motion of the cervical spine while effectively relieving nerve compression. Other alternatives such as Anterior Cervical Discectomy & Fusion (ACDF) or Cervical Disc Replacement will be discussed by A/Prof Buckland in your preoperative consultation.

What Happens During Posterior  Cervical Foraminotomy Surgery?

Preparation

• Hospital Admission: You will be admitted to the hospital on the day of surgery. Fasting is required before the procedure, as directed by your anaesthetist.
• Anaesthesia: The procedure is performed under general anaesthesia, ensuring you are asleep and pain-free throughout the surgery.

Surgical Approach

• Patient Positioning: You will be positioned face down (prone) on the operating table to allow access to the back of your neck. Your head is secured with a specialised frame which anchors your scalp using some pins.
• Incision: A small incision is made in the back of the neck over the affected vertebra. The muscles and soft tissues are carefully moved aside to expose the vertebrae and foramen. The correct operative level is confirmed using intraoperative X-rays.

Foraminotomy Procedure

• Bone Removal: A/Prof Buckland uses specialized instruments to remove small portions of bone and any other tissue (such as ligaments or bone spurs) that are compressing the nerve as it exits the spinal column through the foramen. This widens the foramen and relieves the pressure on the nerve.
• Microscopic Assistance: The procedure is performed using a high-powered surgical microscope to enhance visibility and precision, minimizing the risk of damage to surrounding tissues and nerves, and minimizing the amount of bone that needs to be removed.

Disc Material Removal (if needed)

• If a herniated disc is contributing to the nerve compression, A/Prof Buckland may also remove the protruding portion of the disc (a procedure known as discectomy) to further relieve the pressure on the nerve.

Closure

• The surgical site is carefully closed with sutures, and a sterile dressing is applied to protect the wound. The muscles and tissues are repositioned to minimize the risk of complications.

Postoperative Care and Recovery

Hospital Stay

• Most patients can go home the same day or within 24 hours of the surgery, depending on their recovery progress and overall health.

Pain Management

• Pain is managed with medications, and early mobilization is encouraged to reduce the risk of complications such as blood clots or pneumonia. You may experience some neck discomfort and stiffness in the first few days following surgery.

Outpatient Rehabilitation

• Physiotherapy: Shortly after surgery, a rehabilitation program will be initiated, focusing on restoring neck mobility, strength, and function. Early exercises are typically gentle to avoid stressing the surgical area.
• Activity Restrictions: Patients should avoid heavy lifting, twisting, and overhead activities for several weeks after surgery. A/Prof Buckland’s team will guide their gradual return to normal activities.

Follow-up

• Follow-up appointments will be scheduled to monitor the healing process, assess symptom relief, and adjust your rehabilitation plan as needed.

Risks and Complications

As with any surgery, there are potential risks, including:

• Infection: There is a risk of infection at the surgical site.
• Bleeding: While rare, excessive bleeding during or after surgery is possible.
• Nerve Injury: There is a risk of injury to the spinal nerves, which could result in weakness, numbness, or other neurological symptoms.
• Incomplete Pain Relief: In some cases, the surgery may not fully relieve symptoms, and additional treatment may be necessary.
• Spinal Instability: Although uncommon, there is a small risk of developing instability in the cervical spine, which may require further surgical intervention.