Posterior Cervical Foraminotomy

Abstract

The posterior cervical foraminotomy (PCF) approach was first described by Spurling and Scoville for the treatment of posterolateral cervical soft disc herniations with concordant radiculopathy [1]. Subsequently, multiple surgical series have demonstrated a high rate of clinical success using this approach, citing a low complication rate, morbidity, rate of disk recurrence, and rate of reoperation [2–6]. The ideal management of cervical radiculopathy is still contested. Proponents of the ventral approach argue that the anterior discectomy and fusion (ACF) has less postoperative pain and cervical deformity due to the avoidance of posterior muscular dissection, providing a wider exposure of the pathology affording safe disc removal, as well as a lower rate of iatrogenic nerve injury [7, 8]. One important drawback of the ACF is that it does not preserve mobility. The cervical disc arthroplasty, an alternative anterior option is motion-sparing, but still carries risks inherent to an anterolateral approach. One of the most common complications is dysphagia which can persist after surgery while the least common and most concerning of outcomes is injury to the esophagus or vertebral artery [9]. In the postoperative months, the risks of graft subsidence and pseudoarthrosis are unique to the anterior approach [7]. Moreover, after successful fusion, adjacent segment degeneration (ASD) can complicate an uneventful ACF with approximately a 25% risk of occurrence in the first ten postoperative years [10, 11]. Muscle-sparing tubular approaches for PCF have gained popularity, as well as ‘keyhole foraminotomy’ approaches that allow for less-invasive corridor with microscopic or endoscopic assistance or in conjunction with a muscle-splitting tubular retractor.