Posterior Cervical Foraminotomy

What it is

Through an incision at the back of the neck, the surgeon enlarges the bony opening (foramen) where a nerve exits and removes the fragment or spur pressing on it — without fusing the spine. It is often done with minimally invasive techniques.

When it's used

It's an excellent motion-preserving, fusion-sparing option for a nerve pinched on one side (unilateral radiculopathy), typically from a side-located disc herniation or bone spur — but not for central spinal cord compression. A large randomized trial (the FACET trial) found posterior foraminotomy was noninferior to ACDF for relieving arm pain and overall success at both 1 and 2 years¹. Meta-analyses show comparable arm-pain relief, function, complication, and reoperation rates, with shorter surgery, shorter hospital stay, lower cost, and avoidance of the swallowing problems that can follow a front-of-neck approach.