(This is the the section that explains the detail of the operation or procedure above and should be read in conjunction with the section called your neck operation).
A foraminotomy is an operation performed to relieve pressure on a spinal nerve as it exits the spine through an opening called the foramen. When this is performed in the neck region it is called a cervical foraminotomy. Typically this would be performed to relieve pain, numbness or tingling and possibly weakness in the arm. The nerve that is trapped and compressed determines the precise distribution of the symptoms in the arm. The compression may be caused by bony ridges called osteophytes or by protruding disc material. Whatever the cause, foraminotomy is indicated when the offending structure causing the compression is located laterally, i.e. to the side of the spinal cord. In cases where the pressure is more towards the midline a procedure called anterior discectomy is more appropriate.
For this operation you will be placed under general anaesthetic and then carefully positioned. Some surgeons use an approach where the patient is slouched in a semi-sitting position, while others prefer the patient lying on his/her stomach. The surgeon will then clean and prepare the back of the neck and cut the skin over the appropriate level where compression of the nerve is present. The length of the incision depends on various factors such as patient size, levels involved and surgeons preference. The length of the incision does not have any bearing on the success of your operation. The surgeon then follows a midline approach, which actually means that no muscles have to be cut. The muscles are displaced to the sides and the lamina of the vertebra exposed – this is the flattened part of the back of the bone of the spine. An x-ray is taken to confirm the correct level end the decompression of the nerve is started. This is normally done by using a fine drill to make a keyhole shaped opening in the bone overlying the nerve. If there is any disc material compressing the nerve this may now be removed. Following this the wound is closed in layers using sutures and covered with a dressing.
Ward care
You may get out of bed early following this operation, usually on the first day. You may move around freely as the spine is not destabilised by this operation. Some surgeons may prescribe a soft collar for comfort only. The anaesthetist will have prescribed painkillers for your use after the operation.
Discharge
You would normally not have to spend more than 2 or 3 days in hospital following this operation and you should have relief of your arm symptoms rapidly. Your doctor will make sure you have some pain tablets to take home and will arrange follow up. A sick certificate will be provided if needed.
Rehabilitation
You should allow yourself 2-3 weeks for recovery before returning to work. Allow 8 weeks for proper wound healing before returning to strenuous activity / sport.
Your surgeon could prescribe physiotherapy if you had arm weakness before the operation.
Follow up
Your surgeon will normally see you again within 4 -6 weeks following the surgery and sooner if any complications are present.
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