Patients with persistent nerve symptoms caused by a compressed spinal nerve in the neck may require a decompression operation to relieve the symptoms and prevent further nerve damage. This can be achieved either with an operation at the front of the neck (Anterior Cervical Discectomy Fusion) or the back of the neck (Posterior Cervical Foraminotomy).
The choice of operation will depend several factors including the precise location of nerve compression, the presence of spinal cord compression, the overall condition of the spine as seen on the MRI scan and also the experience and preference of the spinal surgeon.
What is a Posterior Cervical Foraminotomy/Discectomy?
This operation is performed through a small vertical incision at the back of the neck under a general anaesthetic. The operation lasts about one hour and involves removal of tiny bone spurs (Fig 1) (foraminotomy) or a disc prolapse (discectomy) through a small bony window using fine instruments. The procedure is performed using the strong magnification and light of an operating microscope for precision surgery.
An important advantage of a posterior cervical foraminotomy (Fig 2) over an anterior cervical discectomy is that the main disc space is not disturbed, thereby avoiding fusion and preserving disc motion.
What is the success rate?
The procedure has an 80-90% success rate in relieving arm symptoms (brachialgia). The symptoms may not improve immediately as it may take several days or weeks for the nerve swelling to settle. About 5 - 10 % of patients do not experience any improvement, or worsen, despite successful decompression of the nerve root.
Complications affect about 3% of patients in experienced hands. These range from treatable problems such as infection and neck pain to more serious complications such as haemorrhage or limb weakness. Fortunately, potentially serious complications such as weakness are very rare.
As part of the consultation and consent for the operation, your surgeon should be able to provide you with details of his/her success and complication rate for the procedure that is being advised.
What is the recovery time?
The recovery time for this operation is relatively quick. Patients are encouraged to get out of bed and be independent within 4 - 6 hours of the operation. They are usually able to go home after an overnight hospital stay. Most patients are able to drive their car within 7 - 10 days and return to work within 2 to 4 weeks unless their occupation involves heavy physical work in which case it may be longer.