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Procedures: Cervical Posterior Foraminotomy - Images |
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Pathology
The disc herniation compresses the nerve root from the floor of the spinal canal. The shaded area is the roof where removal of bone is performed with the operation. |
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Positioning
The patient is positioned in a tilted and face down position on the operating room table to facilitate exposure of the intended area of surgery |
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Posterior Cervical Spine Approach
The back of the neck is the gateway to the roof. An incision varying from a small stab wound with the Microendoscopic Foraminotomy to the larger incision of posterolateral foraminotomy gives exposure of the bony roof of the spine. In this example, the incision and dissection is on the left side only: the right side bony roof is not shown. |
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The Roof over the Cervical Spinal Nerve
The nerve root leaves the spinal cord and exits to run into the arm to perform the functions of sensation and motion. This drawing shows the area of the roof to be opened to gain access to the nerve and to remove pressure on the nerve. This is the left side only. |
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The Initial Entrance
The facet junction is the beginning of the entrance into the spinal canal. In this drawing, a microsurgical punch is used to trim bone. |
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The Nerve Course
The course of the nerve is shown against the relief of the bone. The roof of bone covers this nerve root. |
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Drilling
Use of high speed drills removes bone without putting pressure on the spinal nerve. The diagram shows how the drill has thinned and the bone removed to reveal the underlying nerve. |
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Venous Cuff
A collection of veins overlies the nerve and may be removed for better visualization of the nerve itself. |
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Nerve Root Freedom
The nerve has been exposed and a microinstrument is used to assess the freedom of the nerve. The inset diagram show the nerve leaving the edge of the spinal cord. Bony roof has been removed and the microinstrument is slid along the course of the nerve to judge its freedom. Once the nerve is adequately decompressed, it moves freely and no pressure is felt. |
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Free Fragment
If a free disc fragment is felt under the nerve root, it can be removed simply with a micro-nerve hook. The consistency of the herniated free fragment is like crab meat. |
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