Posterior Cervical Laminoforaminotomy (PCF)

Posterior cervical laminoforaminotomy, sometimes shortened to PCF, is a neck surgery used to relieve pressure on a pinched nerve in the cervical spine, or neck. The procedure is performed from the back of the neck and creates more space where a nerve exits the spinal canal.

During surgery, the surgeon removes a small amount of bone, thickened tissue or disc material that is pressing on the nerve. This can help relieve symptoms such as neck pain, arm pain, numbness, tingling or weakness caused by nerve compression.

Your provider may recommend this procedure if a pinched nerve in your neck is causing symptoms that travel into the shoulder, arm or hand, such as pain, numbness, tingling or weakness, and those symptoms have not improved with nonsurgical care.

Posterior cervical laminoforaminotomy may be an option for some people because it can relieve pressure on a nerve without fusing the spine using screws and rods. This may help preserve more natural neck movement compared with some fusion procedures and may decrease the risk of future surgeries.

However, it is not right for everyone. Your surgeon will review your symptoms, imaging, spine alignment and overall health before recommending the best treatment option for you.

Your provider may recommend this procedure if a pinched nerve (nerve compression) in your neck is causing symptoms that affect your daily life.

Common reasons for nerve compression include:

• A herniated cervical disc
• Bone spurs from arthritis or age-related spine changes
• Narrowing of the foramen, the opening where nerves leave the spine
• Cervical foraminal stenosis

A foraminotomy enlarges the space around the compressed nerve, which can help improve symptoms related to nerve irritation.

Posterior cervical laminoforaminotomy may help relieve symptoms caused by pressure on a cervical nerve root, including:

• Pain that travels from the neck into the shoulder, arm or hand
• Numbness or tingling in the arm or hand
• Muscle weakness
• Pain that has not improved with nonsurgical care
• Symptoms that interfere with work, sleep or daily activities

The goal of surgery is to reduce pressure on the nerve so it has room to function more normally.

Before Surgery

Before surgery, your care team will review your symptoms, medical history and imaging studies. These may include X-rays, MRI or CT scans. Your provider may also ask about treatments you have already tried, such as:

• Physical therapy
• Anti-inflammatory medications
• Nerve pain medications
• Activity changes
• Steroid injections
• Other nonsurgical treatments

Your surgical team will explain how to prepare, including which medications to stop or continue, when to stop eating or drinking, and what to expect on the day of surgery.

During Posterior Cervical Laminoforaminotomy Surgery

Posterior cervical laminoforaminotomy is performed under anesthesia. Depending on your condition and surgical plan, the procedure may be performed using minimally invasive techniques that use smaller incisions and specialized instruments to access the affected area of the cervical spine.

The surgeon then removes a small amount of bone from the lamina and/or foramen to create more space for the compressed nerve. If a disc fragment or bone spur is pressing on the nerve, the surgeon may remove that as well.

The specific technique may vary depending on your anatomy, the cause of nerve compression and your surgeon’s approach.

Recovery From Posterior Cervical Laminoforaminotomy

Recovery varies from person to person. Many patients go home the same day, while others may stay in the hospital depending on their health, the extent of surgery and their care plan.

Many patients experience relief from arm pain relatively soon after surgery. You may have soreness, stiffness or incisional pain in the back of your neck after surgery. This discomfort typically improves over the first one to two weeks and can often be managed with oral pain medications. During this time, most patients can resume many daily activities but should avoid excessive twisting, bending and lifting to allow the muscles and soft tissues to heal.

Numbness and tingling may take longer to improve, sometimes requiring several months as the nerve continues to recover.

Your provider will give you instructions about activity, lifting restrictions, wound care, medications and follow-up visits. Physical therapy may be recommended to help improve strength, flexibility and safe movement as you recover.

Call your care team if you experience:

• Fever
• Increasing redness, swelling or drainage from the incision
• Worsening pain that does not improve with medication
• New or worsening weakness
• New numbness or tingling
• Trouble walking or using your arms or hands
• Severe headache
• Loss of bowel or bladder control
• Trouble breathing or swallowing

Call 911 or seek emergency care for severe or sudden symptoms.

The main benefit of posterior cervical laminoforaminotomy is relief of nerve compression. This may improve:

• Arm pain
• Neck-related nerve pain
• Numbness or tingling
• Weakness caused by nerve pressure
• Ability to return to normal activities

For some patients, the procedure can relieve symptoms while preserving motion in the neck because fusion is not always required.

All surgeries have risks. Your surgeon will discuss your individual risks based on your condition and overall health.

Possible risks may include:

• Infection
• Bleeding
• Reaction to anesthesia
• Nerve injury
• Spinal fluid leak
• Continued or recurrent pain
• Weakness, numbness or tingling
• Need for additional spine surgery
• Neck stiffness or muscle soreness during recovery

Your care team will review what symptoms to watch for after surgery and when to call your provider.

Posterior cervical laminoforaminotomy may be an option if you have a pinched nerve in the neck and nonsurgical treatments have not provided enough relief. The best treatment depends on the cause and location of nerve compression, your symptoms and your overall spine health.

A strong candidate for this procedure is someone who is active and has upper arm, or radicular, pain caused by a pinched nerve in the neck. This procedure may be an option for those who would like a faster return to heavy labor, work or other activities with less downtime from surgery. This surgery does not address neck pain so neck pain should not be the main symptom. 

A spine specialist can help determine whether this procedure, another type of surgery or continued nonsurgical treatment is the best option for you. At UC Health, our spine specialists take the time to understand your condition, explain your options and help you decide whether continued nonsurgical care, posterior cervical laminoforaminotomy or another treatment is best for you.

At the Back Neck and Spine Center, you have access to multidisciplinary spine experts, including neurology experts from the UC Gardner Neuroscience Institute and orthopaedic specialists from UC Health’s Orthopaedic and Sports Medicine team. These specialists work together to understand the root cause of your symptoms and create a care plan made for you.

Our teams are experienced in treating common, complex and severe spine conditions, with the goal of helping you move forward with confidence and the right level of care for your life. Schedule an appointment online or call 513-418-2225.