Dr. Charla Fischer, a board‑certified orthopedic spine surgeon in New York City whose practice focuses on the cervical spine, performs posterior cervical foraminotomy. Here is how this operation relieves a pinched nerve in the neck without fusing the spine.
What Is a Posterior Cervical Foraminotomy?
A foraminotomy widens the opening where a nerve root leaves the spinal canal, to take pressure off that nerve. That opening is called the foramen. As Dr. Fischer’s foraminotomy page explains, a posterior cervical foraminotomy is performed from the back of the neck, often for a disc herniation on one side. A small opening is made on one side of the lamina, the bone at the back of the spine, and any bone or soft tissue pressing on the nerve is removed.
The bone that is removed isn’t important for the spine’s structural support, so removing it doesn’t cause instability. That is why a posterior foraminotomy doesn’t require a fusion.
Who Is It For?
Foraminotomy treats foraminal stenosis, where the nerve’s exit is too narrow, as well as a disc herniation or bone that is pinching a nerve root. In the neck, a pinched nerve root (cervical radiculopathy) typically causes pain, numbness, tingling or weakness that travels down one arm.
Most people with a pinched nerve in the neck improve over time without surgery. Surgery is considered when symptoms continue despite non-surgical treatment.
Foraminotomy vs. ACDF
A pinched nerve in the neck can also be treated with anterior cervical discectomy and fusion (ACDF), which is done from the front of the neck. Which one fits depends on where the compression is and what is causing it.
| Posterior foraminotomy | ACDF | |
|---|---|---|
| Approach | Back of the neck | Front of the neck |
| What’s removed | Bone or soft tissue narrowing the nerve’s exit | The disc or bone spur |
| Fusion | No | Yes, with graft and plate |
| Often used for | Compression on one side | Disc problems pressing on nerves or the spinal cord |
Surgery and Recovery
A foraminotomy takes about two hours on average, and patients commonly stay overnight for observation. Light activities usually resume four to eight weeks after surgery, and most people go back to work after four to six weeks. Complete recovery can take up to a year.
How Well Does It Work?
Success rates reported for cervical foraminotomy are high. One study of open and minimally invasive cervical foraminotomies reported success rates of 92% to 94%, and another reported 84% to 86%. Results vary from person to person.
Risks
Recognized risks include bleeding, infection, blood clots, nerve damage (weakness, pain or loss of feeling), and spinal instability. Dr. Fischer reviews the risks and alternatives with each patient before surgery.
How to Get Help
If arm pain or numbness from a pinched nerve in your neck hasn’t improved with treatment, a spine specialist can tell you whether a foraminotomy, ACDF or continued non-surgical care is the best fit. Dr. Fischer sees patients at NYU Langone Center for Musculoskeletal Care, 333 East 38th Street, 6th Floor (646-501-7200), and NYU Langone Madison Orthopedic Surgery Associates, 145 East 32nd Street, 4th Floor (212-427-3986). Contact Dr. Fischer to schedule a consultation.
Sources: Cleveland Clinic, Foraminotomy (reviewed Sept 2023); Dr. Fischer’s posterior cervical foraminotomy, ACDF and cervical radiculopathy pages.
Frequently Asked Questions
Is a foraminotomy a major surgery?
It is a real operation done under anesthesia. It takes about two hours on average and patients commonly stay overnight for observation. Because it doesn’t involve a fusion, it avoids the bone-healing stage that a fusion requires.
How long does it take to recover from a foraminotomy?
Light activities usually resume four to eight weeks after surgery, and most people return to work after four to six weeks. Complete recovery can take up to a year.
What is the success rate of cervical foraminotomy?
One study of open and minimally invasive cervical foraminotomies reported success rates of 92% to 94%, and another reported 84% to 86%. Results vary from person to person.
What is the difference between a foraminotomy and ACDF?
A posterior foraminotomy is done from the back of the neck and widens the nerve’s exit without a fusion. ACDF is done from the front, removes the disc or bone spur, and fuses the vertebrae with a graft and plate. Which fits depends on where the compression is and what is causing it.
Does a foraminotomy make the spine unstable?
The bone removed in a posterior cervical foraminotomy isn’t important for the spine’s structural support, so removing it doesn’t cause instability. Spinal instability is still listed among the recognized risks, and your surgeon will review it with you.