Cervical Foraminotomy

History

A right-hand dominant 44 year old Firefighter presented reporting a three month history of right arm pain that radiated to his upper arm. He also reported weakness of the right shoulder and triceps as well as numbness and tingling extending into the thumb, index, and long fingers. Due to symptoms, he experienced issues with fine motor skills and manual manipulation.

Non-operative treatment had included: formal physical therapy, therapeutic massage, a course of oral steroids, anti-inflammatory medication, and epidural steroid injections. He had also been restricted to a light duty with the Fire Department.

Examination

On examination, he was found to have significant weakness in the right biceps, triceps, and wrist extensors with decreased sensation in the thumb, index, and long fingers. He also exhibited greatly restricted cervical range of motion. His triceps reflex was diminished. Spurling’s provocative testing was positive on the right side.

Diagnosis

MRI revealed a C5-C6 and C6-7 disc protrusions resulting in right-sided C5-C6 and C6-C7 neural foraminal stenosis (narrowing) and compression of the exiting C6 and C7 nerve roots. He had a resulting right C6/C7 radiculopathy manifesting in pain, numbness, and weakness of the biceps, triceps, and wrist extension.

Selected Treatment

A discussion was had with the patient on the pros and cons of an ACDF vs. laminoforaminotmy to treat his symptoms. A joint decision was made with the patient to undergo a two level laminoforaminotomy in order to preserve cervical range of motion while treating his symptoms, which was crucial to his profession.