If cervical disc protusions compress the nerves in the neck, arm pain is likely. There are a number of operative ways that this can be managed. But, if suitable, a posterior cervical foraminotomy is a vastly underrated operation which avoids some of the shortcomings of other disc operations. Yet it still has an excellent outcome in terms of symptom relief in a minimally invasive fashion.
The typical patient presents with pain down one arm which may radiate to the hand. Cervical disc problems are exceedingly common and it is important to realize that in the vast majority of cases non-operative management works very well. Most patients settle within 6-12 weeks after the onset of symptoms.
A posterior cervical foraminotomy is a minimally invasive procedure designed to remove any piece of disc which is pushing on the nerve. Interestingly, sometimes the foraminotomy alone can alleviate symptoms without a discectomy being needed. The whole disc is not removed, just the fragment pressing the nerve root. A fusion is not performed and most patients typically do not require a neck collar after the surgery.
Cervical disc protrusions are not usually operated upon early, but there are some clear situations when a surgeon may recommend early surgery. If there is evidence of severe weakness, early surgery may be offered. A posterior cervical foraminotomy is not the operation of choice if a disc protrusion is causing myelopathy as this typically indicates that the compression of the spinal cord is from disc material in front of the cord. Consequently, a posterior approach such as for a cervical foraminotomy is not suited for spinal cord compression and myelopathy.
Conservative management typically works well with patients who are experiencing mild pain. It must be remembered that the vast proportion of patients will settle with time and as long as improvements are noted at six weeks, there is minimal or no weakness, and the pain is not excruciating and is livable with oral analgesia, then waiting and continuing with conservative therapy is a good option.
If weakness occurs and is not improving, surgery is usually offered. Similarly, if symptoms are not improving at six weeks then surgery is an option.
In most cases, when managing just arm pain, surgery is a treatment option that speeds up the rate of recovery, remembering that most cases will get better by themselves. Again, specific recommendations are tailored to the patient. In the vast number of cases, the goal is to control the pain, and any intervention that achieves this and is less invasive than surgery is a reasonable option.