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JBJS Essent Surg Tech. 2016 Jun 8;6(2):e23. doi: 10.2106/JBJS.ST.16.00012. eCollection 2016 Jun 22.

Minimally Invasive Cervical Foraminotomy.

Author information

Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia.
Department of Orthopedics, Mount Sinai Medical Center, New York, NY.



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:

Step 1 Position the Patient Video 1:

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:

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:

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 Video 2:

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 Video 3:

Use a nerve hook to superiorly retract the nerve root, and perform a discectomy and decompression.

Step 6 Wound Closure and Postoperative Care:

Obtain hemostasis with electrocautery or hemostatic foam and close the wound with a standard layered closure.


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.

Pitfalls & Challenges:

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