CERVICAL STENOSIS RADICULOPATHY - PART 4 - THE POSTERIOR FORAMINOTOMY 

Again all your videos are so good. Anyone looking to learn about the procedure or the condition from a reliable physician, just watch these videos. I am an ED physician and i know the value of what he is providing in the channel. There is no waste of words. Thank you so much for doing this.

Thank you. I was worried after I lost quite a bit of strength in my shoulder just this week. Your videos have helped me understand what’s happening and eased my concerns about treatment. Thank you.

Thank you so much for this series. I am currently suffering with what appears to be a C7 issue and your series is tremendously informative and the different issues that may be causing the pain and what can be done. Just having professional take the time to fully explain potential root causes and discuss outcomes is incredibly helpful. Thank you 1000 times, and please know you relieving stress for many people with these videos.

Thanks for keeping us posted-really good info-

Thanks for the vids Doc! I’ll see you Tuesday 🤙

I wish you were in my area!!! You are so patient, and help us understand with ease. Thank you so much!!!

Thank you the 1-3 all extremely helpful.

You've taught me a lot about the disease I have. Thanks Doc.

Thank you DR. ❤️❤️❤️❤️❤️❤️❤️⭐💪

Thank you Dr Su, wonderful discussion.

I like you make it easier to understand.

Thank you!

Thank you for making these incredible videos. 🤗

Good Evening Dr., I have a double fusion with a fixation plate from C5 -C7 .Last procedure was done on 2001 24 12 , I'm in need of two of this procedure on the above levels. I want to thank you as always for the time & knowledge that you give so freely. Sincerely, Ray Donahue

Perfect teaching guide. I am a GI endoscopic suffering from c6 compression without any disc protrusion or prolapse. This video encourages me to undergo surgery. Tnx a lot.

Thanks, goodnight

these serious are also helpful for doctors who treat these patients nonsurgically. Nice to see the reasoning why you may do this over an ACDF

Upon opening the foraminal pass does the nerve know to move over. Does it dart over to decompression

I had a ADCF of the C3-C7 in 2012 at 62, and am in the same situation where again, I am getting all the pains that I had before in 2012, as they say 10 years is about the maximum time for relief? I just had an MRI, I have a protruding discs and spine compression above and below, and am waiting see my surgeon, I will not accept a fusion, as the last one resticted my neck movement, and from watching this, and many other RU-vid cervical surgeries, I see there are limitless ways to fix neck problems than there were in 2012

2.5 weeks since surgery. Foranotomy. Been active. Walking. Mellow hikes. Started stretching gently. By I’ve had pain in arm goes up to shoulder. My check up said inflammation. Gave me steroids. I hope that this can still be successful. Not sure how long I gotta not work out.

Good stuff I recently had a 7 level cervical fusion with laminectomy(severe stenosis C5-L1) and 7 years since a C5-C7 ACDF aside from pain I was losing fine motor skills…basically I couldn’t play guitar specifically my right hand was “clumsy” and I struggled holding things the fusion is C3-T2 my cervical X-rays look like the terminator. It has relieved the pain but I still get tingling and numbness in my ring and pinky fingers on the right hand which I suspect I’m just going to have to live with

Great videos on the spine. Very informative and clear to understand! Could you recommend a video if a patient has bone spurs at more than one level. Which one do you treat or how do you know which level is causing the problem? MRI shows bone spurs at multiple levels both right and left with neural foramina stenosis. Some levels are mild, some moderate and some severe. No disc herniation but slight bulge here and there. Radicular symptoms without significant weakness are on the right. ESI on right x 2 at different levels didn’t really help. 45 yo male athlete with no medical problems developed symptoms 4 months ago after slipping and landing on his head when doing hand stand push-ups. Thanks.

Thank you doc for these videos , I have stenosis on both central and foraminal in the neck but my main symptom is dizziness , can you post a video talking about it? And why do some patients develop it and most of them not ? Thanks doc

Thats me i can move my head down but not look up so i will try getting a specialist chizeling out the back spur on c4.

Hello doctor, i have posterior cervical disc oesteophytes from c3 to c7, causing anterior thecal sac affacement. Posterior foramonitomy surgery will suitable for this problem.

I had my posterior cervical foranotomy 24 hrs ago. C6-7. Bone spurs only. Severe stenosis. Since coming out the only pain I’ve felt is from surgery area. I know I’ve had pain medication. However even between servings I havnt felt pre surgery symptoms. No hand tingle or numbness. Is this a good sign. Surgeon said went well. We’ve decompressed.

How about this op for the lumber level L3?

Dr. Su Can you please post video when pt developes cervical dystonia as a result of neck injury like DJD? What is the prognosis after surgery like acdf? Will CD be resolve or lessen?. Thank you

If this okay with multiple pinched nerves in the neck?

Thanks so much the info which explains PCF in layman terms. Touching on the subject of good candidates , I thought I was till you mentioned arm weakness :( My ride side deltoid and forearm are about 25% weaker (with atrophy) than my left arm but I do have large spurs in C6-C7. I was told I need to do the PCF on 4 levels ( C4-5 C5-6 C6-7 and C7-T1) My biggest issue is that I have a sudden case of winged Scapula but nothing was noticed on 2 EMG tests. Do you think I still may be a candidate? Luckily not much pain or tingling in my fingers or arm. Thanks and keep up the great videos

Well it’s hard to get specific info. It appears that decompression is beginning. My understanding is that the nerve n tissue needs repairing. Healing. Is that true.

What is the risk of nicking a nerve root or cord derma when cutting into the bone? Can you tell from mri/myelogram how much and where you will remove bone and tissue to ensure success?

Hi, very useful. Just wondering approximate portion of those receiving this treatment have to then go on to get ACDF surgery?

Hi Doctor, thank you so much for these videos. We are in CT and are recommended a 4 level ACDF for a pinched nerve at C5-C6-C7 and while they are opening the patient the doctor suggests to fix the congenital cervical stenosis at C3-C5. We rather think we should just handle the actuate problem at C6-C7 that is causing the neck and shoulder pain for the patient for last 3 weeks. What do you suggest? Clinical Indications: Severe right C7 radiculopathy. Rule out disc herniation. Comparison: None. FINDINGS: Note: Image quality is degraded by moderate motion artifact which degrades the sensitivity of this examination for the detection of abnormalities. There is straightening of the cervical lordosis possibly related to muscle spasm. No listhesis is seen. Vertebral body heights are preserved. There is no focal marrow edema. There is multilevel mild intervertebral disc height loss. There is diffuse narrowing of the spinal canal which is attributed to congenitally short pedicles. The spinal cord is normal in signal. There is compression and distortion of the cervical spinal cord at the level of the C6-7 disc. The visualized portions of the posterior fossa are unremarkable. The paravertebral soft tissues are unremarkable. Significant findings by level: C2-3: No posterior disc abnormality/osteophyte formation. Uncovertebral hypertrophy and mild bilateral facet arthropathy result in no neural foraminal or spinal canal stenosis. C3-4: Disc-osteophyte complex, uncovertebral hypertrophy, and mild bilateral facet arthropathy resulting in moderate-to-severe right neural foraminal stenosis and spinal canal narrowing to 6 mm in AP midline. C4-5: Small disc-osteophyte complex, uncovertebral hypertrophy, and mild spinal canal narrowing to 7 mm in AP midline. bilateral facet arthropathy resulting in moderate right neural foraminal stenosis and G5-6: Disc-osteophyte complex with superimposed broad central extrusin; bilatvertebrai hypertrophiy, aher with superimposed a rinropathy resulting in 'mild bilateral neural foraminal stenosis land plea canal narrowing to 5 mm with flattening of the ventral cord contour. C6-7: Disc-osteophyte complex with superimposed right paracentral disc extrusion completely effacing the right nerve root entry zone without uncovertebral hypertrophy or significant facet arthropathy resulting in severe right neural Foraminal stenosis/effacement and spinal canal narrowing to 4 mm in AP midline with associated cord distortion/compression. C7-T1: Small disc bulge. No stenosis. IMPRESSION: Motion-degraded study- Degenerative changes, most pronounced at C6-7 where a right paracentral disc extrusion completely effaces the right nerve root entry zone and results in severe right neural foraminal stenosis and results in severe spinal canal stenosis to 4 mm with cord compression. This corresponds to reported severe right C7 radiculopathy.

Is there any difference between a unilateral and bilateral forminotomy in terms of post surgery weakness / further issues. My scan shows more narrowing right side but symptoms are all left side. Presuming they may do left only but just wondered. Thanks so much for these excellent videos

Sir, the nerve is coming out NOT from the hole where you describe that the bone is removed. Have I just didn't get it right? I thought that the bone, that needs to be removed, is the bone(s) surrounding the coming out root nerve. How removing the bone on the back will remove pressure from the nerve on the front corner?

My back pain is in the middle of my spine and there are no videos to explain this or exercises to get by. All lumbar and cervical, thousands.

Why don’t Drs listen I have told have very very bad spine from waste to tail all very painful also in shoulder up to right to in little hollow at base the 😂of top of please help

I’m having this procedure. Bone spurs. C6-7. Nerve tested ok on emg. Pain, but so far still have use of hand. Is 6 months too long to have waited to do this decompression?

couldn't you just go in from the front and remove the bone spur without fusion or disc replacement?

Hi doc I have cervical stenosis C-3 to C-6 with bone spur pressing on to my spinal cord. Have no pain but mild weakness and tingling of right arm. Surgery was suggested foraminotomy posterior spine segmental 3-6 levels, stereotactic fusion cervical spine each additional level. What do you suggest. No other treatment plan was suggested. Much appreciate your reply

I do have pinching in the side of my neck

Hallo Doctor, can the uncus be removed in the posterior Foraminotomy?

An MRI showed a tumor in my cervical spine pressing on a nerve in the area of C6 I believe. I have numbness in my right middle and index finger and thumb. It has recently spread to my other two fingers. I had an EMG and the doctor recommended carpel tunnel release which I had. This didn't help my numbness. I also had a brain bleed (which the radiologist thought was a tumor) and I had a craniotomy to have it removed. The neurosurgeon said the bleed was in a section of the brain that controlled my right hand finger numbness. The surgery didn't help the numbness. What kind of doctor should I consult next? I realize that without seeing the MRI, you can't make a diagnosis, but do you think it is possible that the tumor in my cervical spine could be causing the problem in my right hand? Thank you.

What does a nerve do. Physiologically after release.

Is this a viable option for someone looking to play competitive tennis post recovery? Thanks.

Yiu are the best. Please cover military neck surgery w bone Spurs, mild to moderate stenosis osteoarthritis and osteoporosis. I am only 58 and suffering. NYC

I had this procedure eight months ago on my C3/C4. I'm in more pain than I was before the surgery. Any reason why this would make me worse? I chose this surgery because I wanted to avoid a fusion.

Dr Su, so how do you stop bone spurs from continuing to form in one's spine?

1week since surgery. Pain from operation retreated to the inscision only. Able to walk so few home things. When up pain worse from surgery. My symptoms pre surgery seem better. Some hand tingling. Hard to tell while still in pain.

What do you have to say about endoscopic posterior foraminatomy for C6/C7 disc herniation pushing on left foraminal nerve with bone spurs? I have a c5/c6 artificial disc and really would prefer as minimally invasive posterior approach as possible. I hear the recovery and long term pain is worse for posterior foramintomies versus my full anterior disc appraoch. I dont even know I have one.

How painful is this surgery compared to a ACDF one level? Most of your patients happy with this procedure?

My surgeon says 1.5 inch incision. How difficult is it getting muscle out of way.

Hi doctor I have a bulging disk at c6-7 Pain in my left arm and neck. I am very interested in the posterior Operation. Am I a good candidate? Thanks

Hi, I’m curious what makes someone a candidate for foraminotomy? It seems like everyone with chronic radiculopathy is a candidate for ACDF or disc replacement but not everyone is candidate for foraminotomy. Thanks

Does Dr.Su have a video on that fusion using a cage instead of cadaver bone? Thank you.

I had Cervical Fusion C5 C6, C6 C7. Im now being scheduled for this procedure youre speaking of same levels next so im thinking after having the 2 ill be better. I can touch an area left of my spine near C5,6 that is a bone spur Pain in left shoulder, arm and left index finger wont bend after 2 years. Whats your opinion please? Im hoping this will be the solution finally!

Today it seems my arm weakness reappeared with shoulder pain. Does this mean failure.

I had severe radiculopathy and has an ACDF C5-7. It has not made the radiculopathy any better. In fact it feels worse after 6 months post op. Another MRI today found moderate to severe c5-6 foraminal stenosis. What can be done for this given I already had ACDF?

What could it mean if one has a post-op severe weakness (palsy-like) and some new numbness without the presentation of nerve pain following a posterior foraminotomy? I recently had a posterior foraminotomy at C3-4 and I believe the decompression worked since my nerve pain is significantly reduced, however, upon waking I gained new right numbness at the trapezius/clavicle and severe weakness (almost palsy-like) in the right deltoid and bicep. Post-MRI and CT scans are both showing moderate foraminal stenosis due to endplate osteophyte and uncovertebral hypertrophy. Thanks again!

I want to ask why have I got pain in my neck and my arm but also my bottom of my legs I m struggling waking when I sit down I am in loads of pain and I’m in pain and stuff when I start to walk also my feet often our burning

If you had prior cervical formantomy at c5 6 are you still eligible for mob c disc

What is your opinion about Ultrasonic procedure to remove some bone spur that is pressing on the spine and causing irritated nerve pain down the arm and hand?

Hi, I’ve heard the this treatment is very effective with treating arm/shoulder pain but not as much with patients having neck pain. Is there truth to that? And if so why? Thank you in advance

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How long do you recommend taking off from work with this surgery? I’m a middle school teacher.

Is this a good option if you still have pain after ACDF? CT shows severe and moderate foraminal stenosis. Shoulder pain and arm pain.

Hypothetically speaking- If someone has EDS- hypermobile - and their MRI shows Disc Osteophyte Complex at every level from 2-7. Broad Herniations at 3/4 and 5/6 with canal diameter of 8. And at most levels there is bilateral facet and foramenal hypertrophy with moderate to severe stenosis. The patient is very symptomatic and has been for years but was putting off surgery due to age - due to a lumbar issue and tried a discectomy on the largest of several herniations unfortunately to wake with leg paralysis and bladder dysfunction that resulted in L3-S1 fusion and hardware. This makes it difficult to do the mjoa in regards to the neck alone. Now the patient is faced with the same circumstances with the neck. Its very hard to find someone that recognizes EDS and the related potential issues - most concerning now is possible craniocervical instability but don’t know anyone locally to test for that. There are Concerns for pressure on the C1/C2. If the patient was 41 and quality of life is greatly affected- How would you proceed with a patient presenting with this circumstance?

After PCF, can ADR be done ?