Posterior Cervical Foraminotomy
Posterior cervical foraminotomy was first described in the mid-twentieth century as a treatment for symptomatic neural foraminal stenosis. This technique is best used in cases of posterior or lateral compression of the nerve root. Because of its high rate
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Christine Boone, Thomas Mroz, C. Rory Goodwin, Timothy Witham, and Daniel Sciubba
Purpose
Planning and Diagnostics
This technique is used to treat symptomatic radiculopathy by removing nerve root compression. A posterior approach allows more direct visualization of the nerve root and decompression without necessitating fusion [1, 2].
The patient’s history, physical exam, and imaging are central in diagnosis and surgical planning. Patients frequently present with radiculopathy symptoms: a dermatomal distribution of diminished sensation, diminished strength, and upper extremity and neck pain. Radiculopathy of C2 or C3 nerve roots is associated with radicular pain over the base of the skull and posterior auricular area. Trapezial and anterior clavicular pain suggests C4 radiculopathy. Weakness of shoulder abduction, diminished biceps reflex, and lateral shoulder pain are frequently observed with C5 radiculopathy. C6 radiculopathy may present with brachioradialis hyporeflexia, thumb and second finger paresthesia, and weakened bicep flexion and wrist extension. Reduced triceps and wrist flexion strength, reduced triceps reflex, and third finger paresthesia are associated with C7 radiculopathy. C8 radiculopathy may present with paresthesia of the fourth and fifth fingers and decreased finger flexion strength [3]. Provocative tests such as the Spurling test or shoulder abduction sign have good specificity for cervical radiculopathy [4, 5]. Because cervical myelopathy is a contraindication for posterior cervical foraminotomy, upper motor neuron signs and symptoms should be excluded [1]. Electromyography (EMG) is occasionally utilized to localize pathology. Imaging is an important part of the preoperative diagnostic and planning process. Cervical spine
Prerequisites Posterior foraminotomy is ideal for patients with symptoms localizing to a single nerve root. Successful decompression of up to three levels has been reported [1]. Nerve compression should be within the neural foramen. Contraindications include spinal cord compression and spondylotic stenosis causing myelopathy. Factors that may increase the risk of iatrogenic instability, such as previous ipsilateral posterior cervical foraminotomy and pre-existing cervical kyphosis, are also contraindications [1]. Electronic Supplementary Material The online version of this chapter (https://doi.org/10.1007/978-3-319-934327_61) contains supplementary material, which is available to authorized users. C. Boone · C. R. Goodwin · T. Witham D. Sciubba (*) Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA e-mail: [email protected] T. Mroz Center for Spine Health, Cleveland Clinic, Cleveland, OH, USA
© Springer Nature Switzerland AG 2019 H. Koller, Y. Robinson (eds.), Cervical Spine Surgery: Standard and Advanced Techniques, https://doi.org/10.1007/978-3-319-93432-7_61
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magnetic resonance imaging (MRI), especially axial T2-weighted, is often used to assess for foraminal stenosis or disc herniation. Computed tomography (CT)
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