I am Dr Tony Mork and I specialize in Endoscopic Spinal Surgery.
There are many people with pain that radiates into the shoulder or arm who get an MRI and find out that they have foraminal stenosis (narrowing) in the cervical spine that compresses one or more nerves in the foraminal canals.
When this pain is no longer responsive to manipulations, physical therapy, or epidurals, surgical treatment of cervical foraminal stenosis may be the only way to relieve the pain, weakness, or tingling.
The pain interferes with sleep and the activities of daily living as well as recreational activities. Some people require the use of pain pills, which they don’t want to take. And then in desperation to get some relief, you take a trip to the surgeon, and he tells you that you need a fusion with a plate, screws and a bone graft!
Sometimes you will hear that if you don’t get it operated on immediately, that you run a significant risk of paralysis!
Since my early days in practice, I have always wanted people to retain as much range of motion as possible; I mean the body is meant to move.
If surgery is necessary then it should be performed through the smallest possible incision with the minimal disturbance of soft tissues And allow the natural motion to continue when possible. I think it’s also wise to operate directly on a problem, when possible, rather than restructure the surrounding anatomy, which is done with a fusion. I always struggled with the concept of creating “one problem” to solve another.
The concept of stenosis is one of narrowing. The narrowing occurs in a bony tunnel (and can for a variety of reasons) with the result of compression on the nerve travelling in the tunnel. The compression on the nerve results in symptoms of cervical foraminal stenosis: pain in the shoulder, arm and hand. It seems logical to decompress the nerve by opening the tight portion of the canal. Is this not the most straightforward approach?
I mean if you could have a small operation to decompress a tight bony canal rather than a fusion that jacks open the disc space to make the foraminal canal larger, wouldn’t you? So my approach is one of nerve decompression through the smallest incision possible and retention of the maximum range of motion in the process, without a fusion.
Endoscopic Spine Surgery, The Minimally Invasive Surgical Approach
Endoscopic spine surgery is mostly about bone removal and decompression for me. I started doing endoscopic spine surgery on the cervical spine about 13 years ago. My practice is devoted exclusively to endoscopic spine surgery and I have never performed a fusion, even on severe cervical spinal stenosis.
Range of motion is preserved or increased and the surgery is directed to the bone pinching the nerve going to the shoulder and arm.
Some bone of the facet is removed but not enough to result in any instability. This was my decision many years back and it has been a good one.
Writing research papers and evaluating results in the practice of medicine is something I did with my associate, Dr. Scott Haufe, for many years.
I was really surprised when we tabulated our data for the two-year follow up of the cervical spine decompression operations that we followed.
Our good to excellent results were 85%, the best results of any spine surgery procedure that I perform. I am presenting that data at an international meeting in Las Vegas in 2011.
Fact is, the results prove a high rate of success is possible without a fusion. A fusion is not necessary to treat symptomatic foraminal stenosis in the cervical spine.
The solution for severe cervical foraminal stenosis is a multi-step process. It starts with pain in the shoulder and arm that won’t go away with conservative measures.
Chances are you have had an MRI and you may have read the report noting foraminal stenosis. The next step is to correlate the pain you have with the nerve being pinched and be sure that they correlate.
Sometimes this requires a selective nerve root block to numb the suspected nerve root with Novocain to see if your pain resolves on a temporary basis. Once the correct nerve root is identified and correlated with a level of foraminal stenosis, then a surgical decompression may be considered.
Over the years, I have managed to operate through a tube that has a diameter smaller than a dime, while one is under IV sedation, often as an outpatient. I was able to operate directly on the foraminal canal and decompress the pinched nerve passing through the narrow canal by removing the bony overgrowth- all this without a fusion.
If you have symptomatic cervical foraminal stenosis, contact my office for free consultation