S Cayli. Posterior Key Hole Foraminotomy. The Internet Journal of Minimally Invasive Spinal Technology. 2010 Volume 4 Number 1.
The goal of minimally invasive spinal surgery is to limit destruction and disruption of muscles, ligaments and joints. Posterior key hole foraminotomy was first described by Frykholm R. in 1947, and then Scoville WB and Whitcomb BB were popularized this technique in 1966. Indication for key hole foraminotomy is intractable radicular pain or neurological deficit due to unilateral disc herniation or small lateral osteophyte. The advantage of key-hole foramibotomy is to offer direct visualization and decompression of the exiting nevre root without fusion.We prefer prone position to avoid complications of sitting position. A linear midline or paramedian skin incision approximately 2 cm in length should be used. After subperiosteal dissection of paraspinal muscles to expose the lamina and medial portion of facet joint, an adequate foraminotomy is performed by high speed drilling. Approximately one-half of the facet joint needs to be removed. After identification of nevre root, the axilla of the nerve root is elevated rostrally by a nerve hook to expose the PLL covering the herniated disc. After opening the PLL herniated disc fragment should be removed. In conclusion, posterior cervical foraminotomy is a safe and effective surgical option for the management of nerve root compression secondary to posterolateral disc herniation or osteophytic foraminal stenosis.