Posterior Cervical Foraminotomy

  • George M. Ghobrial
  • Allan D. LeviEmail author


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.

Supplementary material

Video 17.1

Posterior cervical foraminotomy (M4V 154112 kb)


  1. 1.
    Spurling RG, Segerberg LH. Lateral intervertebral disk lesions in the lower cervical region. J Am Med Assoc. 1953;151:354–9.PubMedGoogle Scholar
  2. 2.
    Raaf JE. Surgical treatment of patients with cervical disk lesions. J Trauma. 1969;9:327–38.CrossRefPubMedGoogle Scholar
  3. 3.
    Murphey F, Simmons JC, Brunson B. Chapter 2. Ruptured cervical discs, 1939 to 1972. Clin Neurosurg. 1973;20:9–17.CrossRefPubMedGoogle Scholar
  4. 4.
    Murphey F, Simmons JC, Brunson B. Surgical treatment of laterally ruptured cervical disc. Review of 648 cases, 1939 to 1972. J Neurosurg. 1973;38:679–83.CrossRefPubMedGoogle Scholar
  5. 5.
    Fager CA. Management of cervical disc lesions and spondylosis by posterior approaches. Clin Neurosurg. 1977;24:488–507.CrossRefPubMedGoogle Scholar
  6. 6.
    Fager CA. Posterior surgical tactics for the neurological syndromes of cervical disc and spondylotic lesions. Clin Neurosurg. 1978;25:218–44.CrossRefPubMedGoogle Scholar
  7. 7.
    Samartzis D, Shen FH, Lyon C, et al. Does rigid instrumentation increase the fusion rate in one-level anterior cervical discectomy and fusion? Spine J. 2004;4:636–43.CrossRefPubMedGoogle Scholar
  8. 8.
    Jagannathan J, Sherman JH, Szabo T, et al. The posterior cervical foraminotomy in the treatment of cervical disc/osteophyte disease: a single-surgeon experience with a minimum of 5 years’ clinical and radiographic follow-up. J Neurosurg Spine. 2009;10:347–56.CrossRefPubMedGoogle Scholar
  9. 9.
    Nandyala SV, Marquez-Lara A, Fineberg SJ, et al. Comparison between cervical total disc replacement and anterior cervical discectomy and fusion of 1 to 2 levels from 2002 to 2009. Spine. 2014;39:53–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Virk SS, Niedermeier S, Yu E, et al. Adjacent segment disease. Orthopedics. 2014;37:547–55.CrossRefPubMedGoogle Scholar
  11. 11.
    Hilibrand AS, Carlson GD, Palumbo MA, et al. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg. 1999;81:519–28.CrossRefPubMedGoogle Scholar
  12. 12.
    Scoville WB, Whitcomb BB. Lateral rupture of cervical intervertebral disks. Postgrad Med. 1966;39:174–80.CrossRefPubMedGoogle Scholar
  13. 13.
    Ruetten S, Komp M, Merk H, et al. Full-endoscopic cervical posterior foraminotomy for the operation of lateral disc herniations using 5.9-mm endoscopes: a prospective, randomized, controlled study. Spine (Phila Pa 1976). 2008;33:940–8.CrossRefGoogle Scholar
  14. 14.
    Skovrlj B, Gologorsky Y, Haque R, et al. Complications, outcomes, and need for fusion after minimally invasive posterior cervical foraminotomy and microdiscectomy. Spine J. 2014;14:2405–11.CrossRefPubMedGoogle Scholar
  15. 15.
    Webb KM, Kaptain G, Sheehan J, et al. Pediculotomy as an adjunct to posterior cervical hemilaminectomy, foraminotomy, and discectomy. Neurosurg Focus. 2002;12:E10.CrossRefPubMedGoogle Scholar
  16. 16.
    Williams RW. Microcervical foraminotomy. A surgical alternative for intractable radicular pain. Spine. 1983;8:708–16.CrossRefPubMedGoogle Scholar
  17. 17.
    Onimus M, Destrumelle N, Gangloff S. Surgical treatment of cervical disk displacement. Anterior or posterior approach?. Rev Chir Orthop Reparatrice Appar Mot. 1995;81:296–301.Google Scholar
  18. 18.
    Herkowitz HN, Kurz LT, Overholt DP. Surgical management of cervical soft disc herniation. A comparison between the anterior and posterior approach. Spine. 1990;15:1026–30.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of Neurological Surgery and The Miami Project to Cure Paralysis, Lois Pope LIFE CenterUniversity of Miami MILLER School of MedicineMiamiUSA

Personalised recommendations