Foraminotomy in the cervical spine
Depending on the location and size of the herniated disc, an operation from the rear can be performed on the cervical spine, the so-called Foraminotomy. This operation has the advantage that the disc remains untouched, and only the prolapsed tissue, called the sequestrum is removed. The disc then can recover and resume its function and the motion segment remains functional. In the case of an operation from the front the entire disc has often to be removed and then replaced with a placeholder (Cage) or an artificial disc. The Foraminotomy can be performed microsurgery or endoscopy. Which method is ultimately chosen depends on several factors, such as the anatomical conditions, size of the so-called interlaminar window and eventual calcification of the incident. The principle is, if it is not complicated then endoscope, when it is more complicated, microscope.
It should also be noted that not all incidents can be operated from the rear. The access is ideal when the incident is far to the side i.e. laterally located. Incidents that are in the center might not be operated from behind, since the spinal cord cannot be pushed aside, literally spoken. Also, calcified disc herniation with narrowing of the spinal canal in the sense of spondylosis cannot be operated from the back either.
Thus, factors such as location, size and type of herniated disc, play a crucial role in the choice of the surgical technique, i.e. whether from the front or rear, whether endoscopic or microsurgical, whether Cage or artificial intervertebral disc.