Introduction 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.
Indications & Contraindications
Step 1: Position the Patient (Video 1) 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.
Step 2: Perform the Skin Incision Make the skin incision adjacent to the spinous process on the side of the abnormality over the operative level.
Step 3: Use Tubular Dilators to Make a Working Portal Use sequential dilators to create a working portal and secure the working tube overlying the lamina-facet junction of the operative level.
Step 4: Perform the Laminoforaminotomy (Video 2) Perform the laminoforaminotomy with the use of a high-speed drill and a Kerrison rongeur to create a working window into the foramen.
Step 5: Perform the Foraminal Decompression (Video 3) Use a nerve hook to superiorly retract the nerve root, and perform a discectomy and decompression.
Step 6: Wound Closure and Postoperative Care Obtain hemostasis with electrocautery or hemostatic foam and close the wound with a standard layered closure.
Results 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.
Pitfalls & Challenges
The minimally invasive posterior cervical foraminotomy, a motion-preserving procedure, is an excellent treatment for patients with unilateral radiculopathy secondary …
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