The Cervical Posterior Foraminotomy Procedure
Sometimes a symptomatic disc herniation is positioned more laterally in the canal or in the window called the foramen. When the disc herniation is lateral to the spinal cord it sometimes may be treated with a keyhole foraminotomy. This is a minimally invasive procedure done from the back of the neck. The incision is guided to the proper level with C-arm X-ray fluoroscopy. A small diameter tube is placed on the posterior-lateral surface of the facet joint. A small burr and surgical instruments are used to clear away a small space of bone and soft tissue overlying the nerve root in the foramen.
Once this has been accomplished the pressure that the disc caused by pushing the nerve into the roof of the foramen is relieved by removing a portion of the roof. Small fragments of the disc herniation may be teased out and removed through this technique. No fusion or artificial disc is needed with this minimalistic approach.