Anterolateral foraminotomy

What is Anterolateral foraminotomy?

Anterolateral foraminotomy is a relatively new and far less invasive surgical procedure than previous treatments, for the relief of arm pain arising from cervical nerve root compression in the neck.

How does it work?

By microsurgically through a small keyhole approach removing only that portion of the compressive disc or osteophyte (arthritic bone overgrowth) causing nerve compression whilst conserving the remaining and still functional portion of the patient’s own natural disc.

What are the benefits over other surgical treatments?

Arm pain due to a trapped nerve root in the neck has traditionally, since the early 1950’s, been treated by radically removing an entire cervical disc to gain access to what is usually just a very small portion of it causing pressure on the nearby nerve. The traditional procedure leads to the permanent loss of that functioning disc and requires either a fusion using a bone graft or the insertion of metallic or plastic implants.

In 1987 Snyder and Bernhardt first described the technique of cervical foraminotomy by an anterolateral approach. The advantages of this technique are its less invasive nature, the preservation of the patient’s own disc with its mobility, avoidance of a painful bone graft or artificial implants and a generally quicker recovery time.

How safe is the surgery?

The surgical approach is initially similar to traditional techniques but then requires far less disturbance of natural anatomical structure. However as with all relatively new techniques it is advisable that a surgeon performing the procedure has had appropriate training in the procedure to ensure safety. Published series 1-3 have demonstrated the effectiveness and safety of this technique as compared to the traditional surgical treatments.

Author: Mr Andre Jackowski, Consultant Neurosurgeon, BSc, MB BS, MD, FRCS based BMI The Priory Hospital.

References:

1. Snyder G, Bernhardt M. Clin. Orthopaed 1989; 246: 92-99
2. Jho H-D J Neurosur (Spine) 2001; 94: 121-125
3. Lee J.-Y et al. Acta Neurochir(Wien) 2006; 148: 951-958

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