Minimally Invasive Cervical Foraminotomy.

[Introduction][1] The 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 & Contraindications][2] [Step 1: Position the Patient][3] ([Video 1][4]) Place 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 Incision][5] Make 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 Portal][6] Use 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][7] ([Video 2][8]) Perform 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][9] ([Video 3][10]) Use a nerve hook to superiorly retract the nerve root, and perform a discectomy and decompression. [Step 6: Wound Closure and Postoperative Care][11] Obtain hemostasis with electrocautery or hemostatic foam and close the wound with a standard layered closure. [Results][12] A 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][13]. [Pitfalls & Challenges][14] [Introduction][1] The 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 & Contraindications][2] [Step 1: Position the Patient][3] ([Video 1][4]) Place 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 Incision][5] Make 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 Portal][6] Use 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][7] ([Video 2][8]) Perform 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][9] ([Video 3][10]) Use a nerve hook to superiorly retract the nerve root, and perform a discectomy and decompression. [Step 6: Wound Closure and Postoperative Care][11] Obtain hemostasis with electrocautery or hemostatic foam and close the wound with a standard layered closure. [Results][12] A 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][13]. [Pitfalls & Challenges][14] [1]: #sec-12 [2]: #sec-13 [3]: #sec-16 [4]: #media-1 [5]: #sec-17 [6]: #sec-18 [7]: #sec-19 [8]: #media-2 [9]: #sec-20 [10]: #media-3 [11]: #sec-21 [12]: #sec-22 [13]: #ref-2 [14]: #sec-23