Spinal Stenosis: Endoscopic Neck Foraminotomy

Spinal Stenosis: Endoscopic Neck Foraminotomy

This animation demonstrates a cervical foraminotomy performed with an endoscope. Small openings called the intervertebral foramina are located between the vertebrae throughout the spine. These openings allow nerve roots to exit from the spinal cord that runs down the center of the spine. Over time, the space within the foramina can get smaller due to disc herniations or bone spurs. This narrowing is called spinal stenosis. A specific kind called foraminal stenosis can put pressure on the exiting nerve roots and cause pain or weakness.

A foraminotomy is a procedure that makes more space in the foramina to relieve nerve compression. This can be performed endoscopically through a small incision, where surgical instruments are inserted through a small tube called an endoscope that contains a light, a camera, and a channel for tools to pass through. Here we see a patient lying face down on the operating table.

After a skin marker is used to mark out where the incision will be made, a needle is inserted and its position is confirmed with x-ray. A small incision is made, a guidewire is inserted into the needle, and the needle is removed. Next, a metal instrument surrounded by a metal tube called a cannula is placed over the guidewire to create space for the endoscope. The cannula is held in place with a clamp, and the instrument is removed.

The endoscope is then passed through the cannula to view inside the neck. Here is a view through the camera of the endoscope. Tools are passed through the endoscope to remove soft tissue covering the spine. An instrument called a burr is used to shave down portions of bone to create more space. More tools are inserted through the endoscope and are used to cut through a ligament called the ligamentum flavum, that covers the back side of the spinal canal. This allows the endoscope to access the affected area.

The affected nerve root is identified and more bone is removed until the pressure on the nerve is relieved. All instruments are removed. The skin incision is closed with a suture, a dressing is applied, and the procedure is complete.