Posterior Cervical Foraminotomy! - Spinal Cord Disorders Message Board

Sam43 · 12-22-2004, 06:24 PM

Today I got a new twist to my neck situation.
(sorry, couldn’t resist)

In going in for a third consult on a cervical disc herniation (c6-c7 with stenosis) I was expecting to set a date for ACDF. Instead, my neurosurgeon, after looking at MRIs taken today and three months ago, has changed his recommendation to Posterior Cervical Foraminotomy. That is, going in from the back of the neck and removing part of the herniated disc, freeing up the pinched nerve and decompressing the spinal cord. There would be no fusion.

He says his thinking is that with the amount of disc degeneration/bulging discs at other levels, this approach would put less stress on other levels and hopefully postpone or prevent other herniations in the future. He made it sound as if more problems are a question of when, not if. But he said this is worth trying.

This threw me and my wife for a loop. We had not heard much about the posterior approach. Our impression is that posterior is more complex and may be more difficult to recover from. Our NS said that isn’t necessarily the case, but that ACDF is much more common because it’s easier to get to the disc. However, with my herniation being more at the back of the neck, he says this is a logical approach.

To be honest, I was somewhat relieved because this will not have the (small) risks to the vocal cords that ACDF poses. However small the risk of my voice being affected, this was one of my main worries about ACDF. Perhaps not completely rational, but it was there.

My quick searches on PCF have not resulted in a lot of positive reviews. But I am aware that a Google search is not the best way to judge the safety of any procedure or treatment.

Has anyone on these boards had this treatment or discussed it with your NS? Any opinions or thoughts? Is the recovery different than for ACDF?

Backinthesaddle · 12-24-2004, 02:18 AM

I had a posterior decompression March of last year for a herniation at C6-7 with severe nerve root compression. The surgery went well and I was not in much pain. I did not use a collar either. I was back to work after 6 weeks and back to working out and carrying on my life. I did have a series of pain injections this year and still have forearm and tricep spasms as well as shoulder spasms. I did have another incident with a minor rear end accident and now have c4-5 moderate to severe stenosis, herniation and a bone spur that is compromising my spinal cord causing cord compression and flattening. I do not know if the weakness from 6-7 added to this. I now also have c7-t1 minor herniations. The next surgery I will have is to remove the bone spur and it will be from the front. So I have two scars then. The scar in the back is not that bad but would rather only have one. Good luck with what you decide.

CTmom · 12-28-2004, 04:55 PM

Hi!

I know three people who have had surgery with a posterior approach.

My mom had it done to remove bone spurs. She was in excruciating pain beforehand, went in in the morning and was home that night. She says she took one pain pill that night and never needed another. The muscles were sore for awhile as they healed well and she is very happy with the result. She was back at work as an OR nurse in two weeks.

My dad had it done years ago. They removed the disc totally and put in a plate - I guess the posterior approach was much more common back then. He said he had pain for a few weeks afterwards but it wasn't that bad. He did not wear a collar and has had no further problems with his neck.

A close friend had the same operation you are going to be having. She had told me the surgery and recovery wasn't bad at all. She is still having problems with pain in her neck, but she has problems at other levels as well.

I'm sure it's like all disc surgery - everyone's experiences vary greatly but based on the people I've talked to about it, it does not seem all that different other than the time it takes for the muscles they cut through to heal. (Although I had a good three months of bad muscle spasms in my back and I had an anterior approach anyway!). Best wishes with whatever your decision!

CTMom

Sam43 · 12-29-2004, 10:42 AM

Thanks for your replies! It is very reassuring to hear from people who have firsthand knowledge of the procedure.
BITS, my surgeon told me to expect 2-4 weeks before returning to work at my computer. Is your work something more physical? I'm hoping to avoid an extended leave from work.
My surgery is scheduled for tomorrow at 7:30 am.
When talking to the surgery scheduler today for the pre-op interview, they had the wrong procedure down (they still had ACDF listed), so we had to get that fixed. A little unnerving, but that's why they do the interviews. Hopefully I won't wake up tomorrow with my appendix removed...
Anyhow, I will post an update when I'm able.
thanks again...

Backinthesaddle · 12-29-2004, 06:00 PM

Hopefully Sam they only take out what needs taking........I am a police officer so for me my job required me to be full duty. I was also on light duty for another 6 weeks before returning full duty. I think that 4 weeks is good to be off. It was the staples and the dressing changes that are hard when you are working. Mine was workman's comp so I could see why you may not want to be off that long. Take what you need and if you feel good enough to go back sooner go for it. The scar isn't to bad either. Not like the one I will get when I have the ADCF of 4-5 that I will need. Good luck.