When is a posterior foraminotomy indicated in cervical radiculopathy?

• A. When foraminal stenosis or lateralized disc herniation compresses the exiting nerve root and anterior approaches are unsuitable.
• B. When foraminal stenosis is absent.
• C. Only after fusion of the cervical spine.
• D. In central canal stenosis without foraminal involvement.

Answer: (A)

The key idea is targeting the exact site of nerve compression. A posterior foraminotomy is used when the exiting cervical nerve root is compressed at the foramen by foraminal stenosis or a lateralized disc herniation. From the back, you can widen the foraminal space and decompress the root without touching the anterior column, which is especially helpful when anterior approaches would be technically difficult or would require more extensive reconstruction. This approach directly relieves radicular symptoms caused by lateral and foraminal pathology while preserving the disc and anterior structures.

It isn’t appropriate when there’s no foraminal narrowing, because decompressing the foramen wouldn’t relieve the radiculopathy. It isn’t restricted to a setting after fusion, and central canal stenosis without foraminal involvement isn’t addressed by a foraminotomy, since the compression lies in the central canal rather than at the foramen.