Endoscopic Foraminotomy of the Lumbar and Cervical Spine

Atlantic Spinal Care performs endoscopic foraminotomy for both the cervical and the lumbar areas of the spine. The two procedures vary slightly so we have provided you information about each below.

Endoscopic Lumbar Foraminotomy (ELF)

Indications: Lumbar spine degeneration, spinal stenosis, foraminal narrowing, radiculitis, radiculopathy, spinal slippage (spondylolisthesis), failed previous surgery, spinal instability, recurrent disc herniation.

Procedures: The patient is brought to operative room with intravenous sedation. Under local anesthesia, a small metal tube the size of a pencil will be inserted to the lumbar spinal nerve hole (neuroforamen). The spinal nerve is found with a camera and protected. Under direct vision, bone spurs, scars, overgrowth ligament, protruded discs, and lumbar facet are removed with laser, radiofrequency, or mechanical tools. The spinal nerves are released from surrounding structures, and the nerve hole is enlarged.

Figure 1. Endoscopic lumbar foraminotomy (ELF) for spinal nerve decompression.

Endoscopic Cervical Foraminotomy (ECF)

Indications: cervical spine degenerative disease with spinal nerve compression, failed previous neck surgery, spinal nerve pinching from disc herniation and bone spurs.

  • Persistent neck pain, shoulder pain, arm pain, or tingling, numbness, and weakness in upper extremities.
  • Positive signs of peripheral nerve compression to upper extremity.
  • Symptoms unresponsive to conservative treatments, such as anti-inflammatory medications, PT, physical therapy, chiropractic adjustments, and spinal steroid injections for 8-12 weeks.
  • Nerve diagnostic test positive for radiculopathy or nerve irritation.
  • Selective nerve root blocks positive for pain relief.
  • CT, discogram, and MRI showing cervical spinal nerve compression.

Procedures: The patient is put under with general anesthesia. A small metal tube of about 4mm in diameter is inserted to the cervical spine nerve canal through the disc under X-ray guidance. A small piece of enlarged bone (ulcinate) is removed with a micro instrument to open nerve canal. Herniated disc, bone spurs, and scars in the spinal nerve canal are removed for satisfactory nerve decompression. The degenerative disc is treated with laser, which vaporizes disc material, kills pain nerves inside the disc, and hardens the disc to prevent leakage of disc material to the surrounding nerves.