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 of success in alleviating symptoms and relatively low risk of complications, it is employed frequently. Approximately 50 years after the introduction of the open approach, minimally invasive adaptations of the technique were developed. The open and minimally invasive approaches allow comparable decompression of the nerve root and similar rates of successful symptom improvement. The minimally invasive approach is associated with decreased blood loss, decreased hospital stay, and reduced postoperative muscle spasm and pain. This chapter reviews the indications, surgical planning considerations, optimal positioning, relevant anatomy, and surgical technique for the open and minimally invasive approaches to the posterior cervical foraminotomy. We also address the potential pitfalls of this technique and identify prophylactic measures to prevent them from occurring.