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Cervical spineMinimally invasive surgery

Cervical foraminotomy (anterior or posterior approach)

Cervical foraminotomy (anterior or posterior approach) is considered for patients with neck pain radiating to the shoulder and arm, often with tingling or weakness caused by nerve root compression in the foramen. When medication, physiotherapy or injections are no longer enough and imaging shows foraminal narrowing or a lateral disc herniation, this surgery frees the nerve via an anterior or posterior approach depending on where the compression is. The goal is to relieve radicular pain while preserving segment stability and motion as much as possible, with indication always personalised based on symptoms and imaging.

Spine neurosurgeon in Alicante and Benidorm
More than 20 years of experience in Neurosurgery (since 2003)
Vithas Medimar Hospital Alicante and Hospital Clínica Benidorm
Medical illustration of cervical foraminotomy to free the nerve root.

What is Cervical foraminotomy (anterior or posterior approach)?

Cervical foraminotomy (anterior or posterior approach) is a surgical procedure to enlarge the cervical foramen, the bony canal where the nerve root exits to the arm, when it is compressed by disc herniation, arthritis, thickened ligaments or other degenerative changes. It can be performed through an anterior approach, reaching the disc and foramen from the front of the neck, or through a posterior approach, creating a small bone “window” around the nerve. The choice depends on compression location, anatomy and clinical factors. Unlike wider decompressions or fusions, foraminotomy targets the affected foramen to relieve radicular pain while preserving as much stability and motion as possible.

Symptoms and warning signs

Patients who may benefit typically show cervical radiculopathy symptoms:

Neck pain radiating to the shoulder, arm and sometimes the hand
Tingling, numbness or “electric shock” sensations in specific fingers or arm areas
Weakness when lifting the arm, gripping objects or performing fine tasks
Pain worsening with certain neck movements, effort or sustained postures
Red flags: sudden or progressive loss of strength, marked difficulty using the arm, gait disturbance, bowel or bladder changes or rapid worsening of symptoms

When is this procedure indicated?

Persistent neck and arm pain despite conservative treatment (analgesics, physiotherapy, injections)
MRI or CT showing foraminal narrowing or lateral disc herniation matching symptoms
Neurological progression with worsening strength, increased tingling or sensory changes in a root distribution
Disabling pain affecting quality of life, sleep or work
Need for a focused root decompression while avoiding more extensive surgery when not required

How is the procedure performed?

1.Preoperative preparation

A full clinical assessment is performed with targeted neurological exam and detailed imaging review to locate the affected root. The neurosurgeon explains the goal, proposed approach (anterior or posterior), alternatives and risks. Fasting instructions are given, medication is reviewed—especially blood thinners or antiplatelets—and hospital admission is planned before signing consent.

2.During the procedure

Under general anaesthesia, foraminotomy can be done via an anterior approach with a small neck incision to reach the disc and foramen, removing compressive material (disc fragments or bone spurs) and enlarging the space; in some cases additional disc or stabilisation steps are performed. Via a posterior approach, an incision in the back of the neck allows selective removal of a small amount of bone and ligament around the foramen to free the root. Intraoperative imaging is used in both approaches to confirm localisation.

3.Immediate postoperative period

After surgery, patients spend time in recovery to monitor awakening from anaesthesia, breathing and pain control, then return to the ward. Mobilisation usually starts early, the same day or next, beginning with getting up and short walks. Strength, sensation and radicular pain are monitored. Hospital stay is typically 24–48 hours, tailored to recovery.

Recovery and daily life

Neck discomfort and some stiffness are common in the first days. Basic mobilisation starts early. Return to office work is often considered between 2 and 3 weeks if pain is controlled; physical jobs with lifting, repetitive shoulder or neck movements, or forced postures usually require 4 to 6 weeks or more depending on recovery. Physiotherapy, progressive strengthening of cervical and shoulder muscles, workplace ergonomics and healthy habits help maintain results. If fever, severe pain, new weakness or worsening tingling appears, prompt review is advised.

Risks and possible complications

As with any spine surgery, cervical foraminotomy (anterior or posterior) carries risks. General risks include anaesthesia-related issues, wound infection, bleeding, haematoma and venous thrombosis. Specific risks include nerve root injury, persistence or lack of pain improvement, segmental instability if too much bone is removed, residual neck pain, and with the anterior approach, temporary swallowing difficulty or voice changes; posterior approach may cause neck muscle pain. These risks are weighed against expected benefits in each case.

Frequently asked questions

It usually lasts between 1 and 2 hours, depending on levels treated and the approach. Additional time is needed for operating room preparation and initial recovery in the PACU. The team will outline the expected duration for your case.
You will not feel pain during surgery because it is performed under general anaesthesia. In the following days, neck discomfort and tightness are common but generally well controlled with medication. Arm pain often improves progressively as the nerve root is freed.
For office work, return is often considered between 2 and 3 weeks if recovery is favourable. Jobs involving lifting, intensive arm use or awkward neck positions typically require 4–6 weeks or more. The timing is adapted during follow-up visits.
Gentle activities such as walking can start early and progressively. High-impact or contact sports and activities requiring wide neck and arm movements are usually reintroduced from around 6–8 weeks depending on recovery and guidance from your surgeon and physiotherapist.
Foraminotomy frees the nerve at the treated level and many patients experience pain relief, but some symptoms may persist and other levels may degenerate over time. Pre-existing nerve irritation can take time to settle. Posture, muscle strength and habits shape long-term outcomes.
Cervical foraminotomy focuses on widening the foramen and freeing the nerve root while preserving motion. Fusion stiffens segments, providing more stability but less movement. Simple discectomy focuses on removing the herniated disc. The choice depends on cause of compression, levels involved and patient factors.
Not always. It is a good option when compression is localised to the foramen and the rest of the spine is stable. If there is more extensive stenosis, deformity or instability, broader procedures may be required. Recommendation is based on imaging and clinical findings for each patient.

Do these symptoms sound familiar?

If you recognise yourself in some of these symptoms and your pain is starting to limit your daily life, we can review your case in a personalised consultation. Dr. Ben Ghezala will assess your clinical history and imaging studies to help you decide the best treatment option for you.

Request a consultation with Dr. Ben Ghezala