Minimally Invasive Cervical Foraminotomy.

Abstract

The minimally invasive posterior cervical foraminotomy, a motion-preserving procedure, is an excellent treatment for patients with unilateral radiculopathy secondary to a laterally located herniated disc or foraminal stenosis. Place the patient in a prone position on a Jackson table with 6 posts and with the head resting comfortably on a soft facial pillow, and tape the shoulders down to provide traction to the skin and help with fluoroscopic visualization of the lower cervical levels. Make the skin incision adjacent to the spinous process on the side of the abnormality over the operative level. Use sequential dilators to create a working portal and secure the working tube overlying the lamina-facet junction of the operative level. Perform the laminoforaminotomy with the use of a high-speed drill and a Kerrison rongeur to create a working window into the foramen. Use a nerve hook to superiorly retract the nerve root, and perform a discectomy and decompression. Obtain hemostasis with electrocautery or hemostatic foam and close the wound with a standard layered closure. A systematic review and meta-analysis of studies on open or minimally invasive surgical (MIS) techniques for posterior cervical foraminotomy showed a pooled clinical success rate of 92.7% for the 509 patients managed with the open technique and 94.9% for the 208 patients who had the MIS technique; the difference was not significant (p = 0.418)².