Best Cervical Foraminotomy Cost In India
A. The Average cost of Cervical Foraminotomy in India started from 5000 USD to 8000 USD depending on your medical condition, hospital location and surgeon experience.
What is Cervical Foraminotomy
A cervical foraminotomy is an operation done from the back of the neck to relieve pressure from spinal nerves. It involves carefully removing a small part of bone and joint which overlie the spinal nerve, as well as any soft tissue which may also be causing compression. In some cases a disc prolapsed is also removed (microdiscectomy).
Why Might I Need A Cervical Foraminotomy?
A cervical foraminotomy is mostly performed to treat pressure on one or more spinal nerves in the neck (caused by foraminal stenosis, cervical spondylosis, or an intervertebral disc prolapse).
This procedure is usually selected when the main problem is arm pain, and there is little or no associated neck pain. Its main benefit is that it avoids using the neck, thereby preserving as much motion as possible.
Surgery is usually suggested when all reasonable conservative measures (pain medications, nerve sheath injections, physical therapies
etc.) have failed. In cases of significant instability or neurological problems, surgery may be the most appropriate first treatment option.
Who needs a Cervical Foraminotomy?
Cervical Foraminotomy is recommended for patients who have bone spurs or herniated discs that are causing cervical nerve root compression. Symptoms of cervical nerve root compression include pain in neck and shoulders. Pins and needles, numbness, tingling, or weakness in the hands and arms are also symptoms.
This surgery is recommended only if the conservative treatments have failed to relieve the pain.
Cervical Foraminotomy is Suggested:
- If there is evidence of severe weakness
- If the pain in the arm is so severe that narcotic analgesia fail to control the pain
- If there is a suggestion of spinal cord compression and myelopathy
What exactly is wrong with my neck?
The spinal canal and intervertebral foramina are bony tunnels in the spine through which run the spinal cord and spinal nerves (nerve roots) respectively. When the size of these tunnels is reduced, there is less room for the spinal nerves and/or spinal cord, the consequence of which may be pressure on these structures.
Disorders that can cause nerve root compression include spinal stenosis, degenerative disc disease, a bulging or prolapsed intervertebral disc, bony spurs (osteophytes), or spondylosis (osteoarthritis of the spine). Commonly, two or more of these conditions are seen together.
Intervertebral discs sit between each bone (vertebrae) in the spine. They act as shock absorbers as well as allowing normal movement between the bones in your neck. Each disc has a strong outer ring of fibres (annulus fibrosus), and a soft jelly-like central portion (nucleus pulposus). The annulus is the toughest part of the disc, and connects each vertebral bone. The soft and juicy nucleus of the disc serves as the main shock absorber. An annular tear is where the annulus fibrosus is torn, often the first event in the process of disc prolapse. An annular tear can cause neck pain with or without arm pain. A cervical disc prolapse (or herniation) occurs when the nucleus pulposus escapes from its usual position and bulges into the spinal canal, sometimes placing pressure on the nerves or spinal cord.
In degenerative disc disease the discs or cushion pads between your vertebrae shrink, causing wearing of the disc, which may lead to herniation. You may also have osteoarthritic areas in your spine. This degeneration and osteoarthritis can cause pain, numbness, tingling and weakness from pressure on the spinal nerves and/or spinal cord.
Osteophytes are abnormal bony spurs which form as part of the degenerative process or following a longstanding disc prolapse. This extra bone formation can cause spinal stenosis as well as intervertebral foraminal stenosis, resulting in compression of the spinal cord and/or spinal nerves.
What are the symptoms of Cervical Foraminotomy?
- Pain
- Aching or stiffness
- Numbness
- Tingling sensations
- Weakness
- in the arm(s) and/or hand(s).
What are the Alternatives of Cervical Foraminotomy?
Most cervical spine disease is initially treated with conservative options. Common treatments include, rest, lifestyle modification, physical therapy, massage, chiropractic care, home exercises, medications and steroid injections. Treatments may be used in any number or combination, but surgical options, such as a cervical foraminotomy surgery, are considered if the conservative options do not bring relief.
Pain medications. A number of medications may be useful for pain. These include the standard opioid and non-opioid analgesic agents, membrane stabilising agents and anticonvulsants, as well as the most recent agent to be released- Pregabalin. Special medical treatments such as Ketamine infusions may be appropriate in some situations.
Nerve sheath injections. Local anaesthetic may be injected through the skin of the neck, under CT scan guidance, around the compressed nerve. This is also known as a ‘foraminal block’. Patients frequently obtain a significant benefit from this procedure, and surgery can sometimes be delayed or even avoided. Unfortunately, the benefit obtained from this procedure is usually only temporary, and it tends to wear off after several days, weeks, or sometimes months. This procedure is also an excellent diagnostic tool, especially when the MRI scan suggests that multiple nerves are compressed and your neurosurgeon would like to know exactly which nerve is causing your symptoms.
Physical therapies. These include physiotherapy, osteopathy, hydrotherapy and massage. Activity modification. Sometimes simply modifying your workplace and recreational activities, to avoid heavy lifting and repetitive neck or arm movements, allows the healing process to occur more quickly.
Other surgical approaches. These include cervical laminectomy, anterior cervical decompression and fusion (ACDF), and an artificial disc replacement. You should discuss these alternatives, together with their potential risks and benefits, with your neurosurgeon.
What are the Risks of Cervical Foraminotomy?
Generally, surgery is fairly safe and major complications are uncommon. The chance of a minor complication is around 3 or 4%, and the risk of a major complication is 1 or 2%. Over 90% of patients should come through their surgery without complications.
- Worsening of pain/weakness/numbness
- Infection
- Blood clot in wound requiring urgent surgery to relieve pressure
- Recurrent disc prolapse or nerve compression
- Nerve damage (weakness, numbness, pain) occurs in less than 1%
- Wound breakdown
- Drug allergies
- Myocardial infarction (‘heart attack’)
- Stroke
Will I need further Investigations?
Most patients will have had X-rays of their neck, as well as a CT scan and MRI.
In some patients there is uncertainty either about the diagnosis or exactly which disc or discs in the neck are responsible for their symptoms: in those patients, nerve conduction studies and/or a nerve block may shed light on the diagnostic issues.
If you have not had an MRI for over 12 months before your surgery, or if your symptoms have changed significantly since your most recent MRI, then this investigation will need to be repeated to make sure that there are no surprises at the time of surgery!
Who will perform Surgery?
Surgery will be carried out by your Precision Neurosurgery surgeon. A surgical assistant will be present and an experienced consultant anaesthetist will be responsible for your general anaesthetic.
Before Procedure
Inform your surgeon. what medicines you are taking. This includes medicines, supplements, or herbs you bought without a prescription.
Prepare your home for when you leave the hospital after surgery.
If you are a smoker, you need to stop. Your recovery will be slower and possibly not as good if you continue to smoke. Ask your doctor for help.
For the one week before surgery, you may be asked to stop taking blood thinners. Some of these drugs are aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn). If you are taking warfarin (Coumadin), dabigatran (Pradaxa), apixaban (Eliquis), rivaroxaban (Xarelto), or clopidogrel (Plavix), talk with your surgeon before stopping or changing how you take these drugs.
If you have diabetes, heart disease, or other medical problems, your surgeon will ask you to see your regular doctor.
Talk with your surgeon if you have been drinking a lot of alcohol.
Ask your surgeon which medicines you should still take on the day of the surgery.
Let your surgeon know right away if you get a cold, flu, fever, herpes breakout, or other illnesses.
You may want to visit a physical therapist to learn exercises to do before surgery and to practice using crutches.
On the day of the surgery:
- You will likely be asked not to drink or eat anything for 6 to 12 hours before the procedure.
- Take the medicines your surgeon told you to take with a small sip of water.
- Bring your cane, walker, or wheelchair if you have one already. Also bring shoes with flat, non skid soles.
- Arrive at the hospital on time.
How is Cervical Foraminotomy Performed?
You will be given a general anaesthetic to put you to sleep.
A breathing tube (endotracheal tube) will be inserted and you will be given a dose of antibiotics to help prevent infection.
You will be placed face down on a special operating table, and your head secured in place with a special clamp. This ensures your neck does not move throughout the procedure.
Calf compression devices will be attached to your legs, helping to minimise the risk of developing blood clots in your legs.
An X-ray will be taken to identify and mark the level of the spine requiring surgery.
A small incision is made over the area of the spine to be treated, and the muscle is moved aside with a retractor.
Microsurgical instruments are used to carefully remove a small amount of bone that serves as the outer wall of the foramen. Once the foramen is opened the nerve root can be seen. Any bone, ligament, disc or soft tissue that is compressing the nerve will be removed using special instruments.
This creates more room for the nerve root to pass through the foramen and relieves the pressure, allowing it to move freely.
Once the decompression has been performed, the retractor is withdrawn, and the skin is closed using absorbable sutures that do not need to be removed.
A small dressing is applied.
Recovery from Cervical Foraminotomy
After surgery you will be shifted to the recovery room. you ill be able to mobilise the same day as the surgery is performed, and stay in hospital for 2-3 days.
It is usual to feel some pain after surgery, especially at the incision site, and have some associated neck tightness, but generally this should decrease a little each day.
You will be discharged with pain relief medications to manage this, and given a booklet outlining all postoperative instructions.
Once home, frequent short walks are recommended. This will help in your recovery and also reduces the risk of blood clots forming in your legs. A gradual increase in physical activity is advised.
You must not lift anything heavier than 5kg for the first 6 weeks postoperatively and avoid twisting and bending movements. Avoid housework such as vacuuming, mowing and hanging washing on the line for the first 6 weeks postoperatively.
Ensure you maintain correct posture when working in front of a computer. You will need to take frequent breaks, as sitting for prolonged periods will cause your neck to stiffen and your posture to deteriorate.
You may drive 1 week after surgery if you are comfortable to do so but avoid long distances.
Physiotherapy is recommended 2 to 3 weeks after your surgery. Gentle stretches and postural control exercises will help to strengthen your neck after surgery.
Keep your wound dry, you will be given extra waterproof dressings on discharge. You may shower as normal but if your dressing becomes waterlogged it should be changed.
Your doctor will discuss resuming sports and other physical activity at your 6 week appointment
Please note that it is common to have localised neck pain for up to 4-6 weeks. This will generally resolve spontaneously and is due to the sensitivity of the cervical musculature.
Depending on the degree of nerve compression, it is also very common to have some degree of arm discomfort, as it will take time for the compressed nerve to recover. Please do not be alarmed if you have some intermittent arm pain, as this is a normal part of the healing process.It is usual to feel some pain after surgery, especially at the incision site.
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Frequently Asked Questions About cervical Foraminotomy?
Q. What happens after posterior cervical Foraminotomy?
A. You may experience increased pain during the first few weeks following surgery. You should expect increased soreness directly at the incision site, which should improve with time. Some patients may experience worsening pain. These symptoms also should gradually improve with time.
Q. How should I sleep after cervical neck surgery?
A. The best sleeping position to reduce your pain after surgery is either on your back with your knees bent and a pillow under your knees or on your side with your knees bent and a pillow between your legs.
Q. What is the Cervical foraminotomy success rate in India?
Posterior cervical foraminotomy has been well de- scribed in the literature. The immediate success rates for symptom resolution vary from 82% to 100%, but long-term outcomes are even more variable, with success rates ranging from 75% to 97%.