Introduction: The minimally invasive posterior cervical foraminotomy, a motion-preserving procedure, is an excellent treatment for patients with unilateral radiculopathy secondary to a laterally located herniated disc or foraminal stenosis. Indications & Contraindications: null Step 1 Position the Patient Video 1: Place the patient in a prone position on a Jackson table with 6 posts and with the head resting comfortably on a soft facial pillow, and tape the shoulders down to provide traction to the skin and help with fluoroscopic visualization of the lower cervical levels. Step 2 Perform the Skin Incision: Make the skin incision adjacent to the spinous process on the side of the abnormality over the operative level. Step 3 Use Tubular Dilators to Make a Working Portal: Use sequential dilators to create a working portal and secure the working tube overlying the lamina-facet junction of the operative level. Step 4 Perform the Laminoforaminotomy Video 2: Perform the laminoforaminotomy with the use of a high-speed drill and a Kerrison rongeur to create a working window into the foramen. Step 5 Perform the Foraminal Decompression Video 3: Use a nerve hook to superiorly retract the nerve root, and perform a discectomy and decompression. Step 6 Wound Closure and Postoperative Care: Obtain hemostasis with electrocautery or hemostatic foam and close the wound with a standard layered closure. Results: A systematic review and meta-analysis of studies on open or minimally invasive surgical (MIS) techniques for posterior cervical foraminotomy showed a pooled clinical success rate of 92.7% for the 509 patients managed with the open technique and 94.9% for the 208 patients who had the MIS technique; the difference was not significant (p = 0.418)2. Pitfalls & Challenges: null
