Foraminotomy and Facetectomy for Cervical Spinal Stenosis

Cervical spinal stenosis may be a consequence of the abnormal growth of bone spurs in the neck. These can cause the foramen, where the cervical spinal nerves exit at each vertebral level (apart from C1), to become narrow leading to pinched nerves. Where osteophyte growth in the foramina has occurred, the usual back surgery operation will involve the use of a burr (small surgical saw) to shave the edges of the foramen and widen the space for the spinal nerves to pass through. Some people may have congenitally narrow foramina making spinal stenosis more likely, and only a small amount of bony growth, or a slight herniation or bulging of an intervertebral disc can cause nerve compression for these unfortunate patients. A foraminotomy can have the effect of almost instantly relieving the symptoms of cervical spinal stenosis, although some residual numbness, weakness, and pain is usual as the nerve heals.

Patients who have a longer history of nerve compression may, however, never be completely symptom free as the nerve damage could be beyond repair. Some numbness, weakness, and altered sensation or pain may persist for these patients. A foraminotomy may also allow a surgeon to perform a partial discectomy to remove disc fragments that have herniated or ruptured and are impinging on the nerves. A foraminotomy is not usually followed by fusion as the spine’s structure and stability is largely unaffected by the procedure.

Rapid Degeneration in Cervical Spinal Stenosis

Due to the high degree of movement in the cervical spine, the development of degeneration in the tissues and bones can occur with alarming rapidity, particularly in the presence of other compromising factors such as acute injury or an inflammatory condition. Where the facet joint itself has become the cause of compression in the cervical spine, the whole of the joint on one side may be removed, or a part thereof. As rheumatoid arthritis is a condition where the synovial joints degenerate, it is possible that the lubrication of the facet joints has been eroded in cervical spinal stenosis, causing the bones to rub together and osteophytes to form. The removal of the facet joint, and subsequent spinal fusion, can help alleviate neck pain from nerve and cord compression and restore the stability of the cervical spine to avoid painful neck movement. Calcified ligaments may be both the cause and effect of facet joint disease and are also likely to be removed during a facetectomy in order to aid spinal decompression.

Alternative Back Surgery Options for Cervical Spinal Stenosis –> ACDF