Posterior Cervical Foraminotomy

Most pinched nerves in the neck settle without surgery. When one doesn't, posterior cervical foraminotomy can free the nerve through a small keyhole cut at the back of the neck, without fusing the bones. Most people walk on the day of surgery and go home the next day.

Reviewed by Dr. Kshitij Chaudhary. Last reviewed October 2026

What is posterior cervical foraminotomy?

Posterior means the surgeon works from the back of the neck. Foramen is the small opening where a nerve leaves the spine. Otomy means making an opening. So this is an operation to widen that opening and free the nerve.

Through a small cut at the back of the neck, the surgeon removes a little bone, and sometimes a small piece of disc, from the side of the spine. We usually do this with a tubular (keyhole) technique. The nerve gets room again. The disc is not taken out and no bones are fused.

Why would a nerve in the neck need more room?

Nerves leave your neck through tight openings. A disc that has slipped sideways or a bone spur can narrow the opening and press on the nerve. This causes pain, tingling or weakness running into one arm.

Read more: Cervical Radiculopathy, Cervical Disc Herniation and Cervical Spondylosis.

Who needs this surgery?

Most people don't. Arm pain from a pinched nerve usually improves over 6 to 12 weeks with medicines, physiotherapy, a soft collar and sometimes an injection. Surgery is worth discussing if:

• Your arm pain is still severe after 6 to 12 weeks of proper treatment
• Your MRI shows a nerve squeezed on one side, matching your symptoms
• Your arm or hand is getting weaker

If you've been told you need surgery and want to be sure, you can send us your MRI for a second opinion →

Who is it not suitable for?

It works for a single pinched nerve. It is usually not the right choice if:

• The spinal cord itself is being squeezed, causing clumsy hands or unsteady walking
• Several levels are narrowed
• The neck is unstable or bent forward
• Your pain is mostly in the neck, with little arm pain

In these situations another operation is usually better. We'll explain which one and why.

What are the other options?

• Non-surgical care: soft collar, a short course of oral steroids, physiotherapy, and a cervical epidural injection for selected people. We use traction very rarely.
• ACDF: the disc is removed from the front of the neck and the level is fused. ACDF →
• Cervical disc replacement: an artificial disc that keeps movement, in selected patients. Cervical Disc Replacement →
• Surgery for the spinal cord: Cervical Laminoplasty when several levels are narrowed.

Why choose foraminotomy over ACDF?

The main benefit is that the neck keeps its natural movement, because nothing is fused. The cut is at the back, there is no graft or plate, and recovery is usually quick. The trade-off is that the disc stays in place, so a disc problem can come back on the same side.

Why a keyhole technique?

With the tubular technique, a thin tube is passed between the muscle fibres, so the muscles are spread apart instead of cut. This usually means less soreness in the neck and a faster return to normal. Occasionally a slightly larger open approach is better, for example when more than one level needs freeing. Read more: Minimally Invasive Surgery.

How is the operation done?

1. You're under general anaesthesia, so you're asleep throughout.
2. You lie face down, with your head held steady and your neck gently flexed.
3. The surgeon makes a small cut at the back of the neck and passes a thin tubular retractor between the muscle fibres.
4. An X-ray confirms the correct level.
5. Through the tube, a small amount of bone is removed to widen the opening. A microscope gives a clear view of the nerve.
6. If a piece of disc or a spur is pressing on the nerve, it's removed. The nerve is checked until it's free and moves easily.
7. The tube is withdrawn, the muscles fall back into place, and the skin is closed with stitches that dissolve.

Will it help my neck pain?

Foraminotomy works best for arm pain, tingling and numbness from a pinched nerve. Neck pain and stiffness may improve, but they aren't the main target. If your pain is mostly in the neck and your nerves are fine, this isn't the answer, and we'll tell you so.

How well does it work?

Arm pain often eases within days. Numbness and weakness are slower, because nerves heal slowly. Most people do well, and earlier treatment gives better results. Some people have a sore neck for a few weeks, mostly from the muscles.

What are the risks?

Every operation has risks, and we'll go through them with you before you decide. They include:

• Symptoms that don't fully improve, especially if the nerve was pressed for a long time
• The disc pushing out again at the same level. Further surgery, such as ACDF, is occasionally needed.
• Neck stiffness or soreness in the first weeks
• Shoulder weakness from nerve irritation, which usually recovers on its own
• Infection, bleeding or a small tear in the nerve covering. All are uncommon.

Serious injury to the nerve or spinal cord is rare.

How can I prepare?

• Stop smoking, ideally weeks before surgery
• Keep your blood sugar well controlled if you have diabetes
• Tell us about every medicine you take. Blood thinners, aspirin, fish oil and herbal medicines may need to be stopped beforehand.

What is recovery like?

Most people walk on the day of surgery and go home the next day. The timeline below is for people who were already walking normally before surgery. If you had weakness or trouble walking, recovery can take longer, and we'll plan it with you.

Questions to ask your surgeon

• Which nerve is the problem, and does my MRI match my symptoms?
• Have I tried enough non-surgical treatment?
• Is my spinal cord being pressed?
• Why foraminotomy for me, and not ACDF or disc replacement?
• How likely is the problem to come back?
• When can I return to work and exercise?

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About Dr. Kshitij Chaudhary

This page was written by Dr. Kshitij Chaudhary, a fellowship-trained spine surgeon at P.D. Hinduja Hospital, Mumbai, trained in complex spine surgery at Harvard Medical School (Beth Israel Deaconess) and the Twin Cities Spine Center, Minneapolis. 🏃🏾About Dr. Chaudhary

This page is for general information. It doesn't replace advice from your own doctor.