Minimally Invasive Cervical Foraminotomy.

IntroductionThe minimally invasive posterior cervical foraminotomy, a motion-preserving procedure, is an excellent treatment for patients with unilateral radiculopathy secondary to a laterally located herniated disc or foraminal stenosis.Indications & contraindicationsStep 1 position the patient video 1Place the patient in a prone position on a Jackson table with 6 posts and with the head resting comfortably on a soft facial pillow, and tape the shoulders down to provide traction to the skin and help with fluoroscopic visualization of the lower cervical levels.Step 2 perform the skin incisionMake the skin incision adjacent to the spinous process on the side of the abnormality over the operative level.Step 3 use tubular dilators to make a working portalUse sequential dilators to create a working portal and secure the working tube overlying the lamina-facet junction of the operative level.Step 4 perform the laminoforaminotomy video 2Perform the laminoforaminotomy with the use of a high-speed drill and a Kerrison rongeur to create a working window into the foramen.Step 5 perform the foraminal decompression video 3Use a nerve hook to superiorly retract the nerve root, and perform a discectomy and decompression.Step 6 wound closure and postoperative careObtain hemostasis with electrocautery or hemostatic foam and close the wound with a standard layered closure.ResultsA systematic review and meta-analysis of studies on open or minimally invasive surgical (MIS) techniques for posterior cervical foraminotomy showed a pooled clinical success rate of 92.7% for the 509 patients managed with the open technique and 94.9% for the 208 patients who had the MIS technique; the difference was not significant (p = 0.418)2.Pitfalls & challenges