Anterolateral cervical foraminotomy (surgery for arm nerve pain)

The cost of anterolateral foraminotomy with Circle Health Group depends on a variety of factors, including is the reasons you are having surgery, and which hospital you choose. Your healthcare team will ensure you know the cost of your treatment at every stage of your journey with them, including information on how and when to pay it.

Fixed-price packages

Our fixed-price packages include the cost of your surgery and all appropriate aftercare appointments. However, any pre-surgery diagnostic tests and your consultant's outpatient appointment fee are charged separately.

Spread the cost of your payment

Our flexible payment options help you spread the cost of your payment across a time period that suits you. We offer fixed-term monthly payment plans over 10 months to five years with no deposit required. If you decide to pay over 10 months, you will pay interest-free. If you are paying for a longer period, you will pay 14.9% APR.

Private health insurance

If you have private health insurance, your treatment will usually be covered by your provider. Speak to your insurer directly to find out more information on this.

If you have any questions about our fixed-price packages and flexible payment options, you can speak to a friendly member of our advisory team on 0141 300 5009

Common symptoms that can lead to anterolateral foraminotomy

We recommend anterolateral foraminotomy when you have severe symptoms that interfere with your daily life and haven't improved with more conservative treatment methods, such as medication or physiotherapy. These symptoms could include:

• A deep and steady and/or burning pain in your arms, shoulder, or hands
• Pain when doing certain activities (for example lifting), or when moving your body in a particular way
• Numbness and tingling sensations
• Problems holding things
• Stiffness

Anterolateral foraminotomy is one treatment option used when a nerve root becomes compressed in your cervical spine. Your cervical spine is found in your neck area. It comprises seven bones that are separated by intervertebral discs.

These discs are like cushions that sit between the bones in your spinal canal and absorb pressure put on your spine. When the spinal canal diminishes in size, it is possible for a spinal nerve to press against one of these discs, which can lead to nerve pain in your arm or shoulder.

While anterolateral cervical foraminotomy targets trapped nerves in your neck area (or cervical spine), nerve compression can happen along any part of your spinal column. The foraminotomy procedure is essentially a process of enlarging the area around one of the bones in your spinal column, thereby relieving pressure on compressed (or trapped) nerves. 'Anterolateral' refers to the method of surgery, specifically to the way that a surgeon accesses a spine to operate on it.

The kind of spinal compression you have is determined by where the affected nerve sits. Some issues that can cause spinal compression include:

• Slipped disc in your lower back
• Pressure on your spinal cord or nerves in your lower spine
• Degenerative arthritis of your spine (from old age)
• Degeneration of one or multiple intervertebral discs
• Enlargement of a nearby ligament
• Cysts or tumours
• Skeletal diseases
• Congenital problems (like dwarfism)

Anterolateral foraminotomy is not suitable for all cervical spine problems. Your consultant will be able to confirm whether this type of surgery could help you.

Your consultant will ask you questions about your symptoms and check if you have a history of nerve pain in your arm or anywhere else, alongside how long you've been living with your current symptoms. They will examine your neck, arms, shoulders, and wrists and hands, as this helps them find the source of the nerve compression. This process also involves looking for muscle weakness, changes in reflexes, and checking the sensation you feel during these tests.

Generally, as a starting point, your consultant will prescribe a combination of pain relief medication and arm nerve pain exercises. You might be recommended physiotherapy and/or massage therapy. They may also give you a nerve sheath injection - a local anaesthetic injected through the skin of your neck that targets the compressed nerve, which can make a significant difference, sometimes to the point where surgery is unnecessary.

If the above non-surgical methods don't work, or you have a history of arm pain due to a trapped nerve, your consultant may decide surgery is the best option for you. In order to see whether anterolateral foraminotomy is right for you, they might run tests including:

Electromyography

This test measures the electrical signals in your muscles and can tell whether your nerves are working as they should be.

MRI scan

This shows whether there's any damage to soft tissues that may be causing a trapped nerve and pain in your arm, or whether there's damage to your spinal cord.

X-ray

This uncovers whether there's any narrowing or changing alignment of your spinal cord, along with any fractures that might be present.

By running these tests, your consultant will be able to tell whether you have a compressed nerve in your neck and confirm whether we should move forward with the surgery.

Avoid eating and drinking

As is usually the case, you will need to avoid eating or drinking anything after midnight on the day of your anterolateral foraminotomy.

Avoid alcohol

Your consultant will encourage you to refrain from drinking alcohol 48 hours before the procedure.

Stop smoking

If you are a smoker, you need to stop before the surgery. It could cause problems with the anaesthesia and negatively affect your breathing after surgery. Your recovery may be slower and possibly not as effective if you continue to smoke following the procedure.

Medications

If you are taking any blood-thinning medications, such as aspirin, you will need to stop taking these at least two weeks before the surgery to prevent any unwanted bleeding during and/or after the surgery.

Stock up on supplies

Rest is incredibly important for the first week after surgery, so make sure you have all the supplies you need at home beforehand. Should you want any additional bits and pieces following the operation, ask a member of your support network to grab them for you, for example a friend or relative.

Anterolateral foraminotomy is carried out under general anaesthetic, which means you'll be asleep the whole time and won't feel any pain at all.

During the procedure, you'll be lying on your stomach, with your head resting in a special fixation device. Your surgeon will begin by making a small keyhole incision at the part of your neck where the compressed nerve sits against your vertebra. Using X-rays, a special microscope, and other tools, they will push away muscles to expose the spinal canal. They will then be able to access the part of the disc that is causing compression against the nerves and remove it using small tools. Where possible, only the area of your disc causing you problems will be removed, and the functioning portion of your disc will be left alone.

After making sure the nerves are completely free, your surgeon will remove the tools, put the muscles back into place, irrigate the small incision with antibiotic solution, and then close it up.

Recovering at the hospital

When you first wake up after the operation, you may feel a bit groggy. This is completely normal as the general anaesthetic wears off. There might be some pain from where we made the incision, but we'll make sure you have as much pain relief as you need to feel comfortable.

You should be able to sit up two hours after the surgery, and we'll encourage you to move your neck carefully. You'll have to wear a soft neck collar for a while afterwards. We'll most likely be able to discharge you from the hospital the day after your foraminotomy.

Two to seven days after surgery

After getting home from hospital, you'll need to take it easy. There might be some remaining pain, for which we'll provide medication, and there's a good chance you'll feel quite tired. If possible, have some help nearby for this first week, as even simple tasks will feel like a challenge. You'll need to avoid certain movements, such as bending your neck.

The wound, at first, will be covered with a dressing that you'll need to keep dry. If your surgeon used non-dissolvable stitches or staples to close the wound, these will be removed five to 10 days after surgery. We'll make an appointment for you to get this done.

One to four weeks after surgery

For the first four weeks after anterolateral foraminotomy, you will still need to avoid certain movements, such as bending, lifting, or twisting. We will provide a physical rehabilitation programme - small exercises that support you on your journey back to full strength, such as taking short walks throughout the day - as well as guidance around activities that you can and can't do. Driving, for example, might not be possible for about four weeks.

If your job doesn't involve any physical exertion (i.e. a desk job), you should be able to return to light work in two to four weeks. When it comes to jobs that require strenuous activities like driving or heavy lifting, on the other hand, you will need more time off – possibly a few months. Please speak to your consultant about this to learn more about your recovery timeframe.

Every individual recovery timeline is different and influenced by a range of factors, such as your age and the severity of the problem, so you might be back to 100% sooner than these averages, or the process may take a little longer than expected.

Do not hesitate to ask your consultant any questions about your recovery period during your appointments with them. They will understand your personal circumstances better and be able to offer you a more personalised timeline based on your situation and recovery goals. No question is a silly question - we're here to help you feel safe and informed before and after surgery.

Potential risks and complications of anterolateral foraminotomy

Complications can sometimes occur, as is the case with any surgery, but these are extremely rare.

General complications of any operation:

• Pain
• Bleeding
• Infection of the surgical incision
• Unsightly scarring
• Blood clots
• Difficulty urinating
• Chest infection
• Heart attack or stroke

Specific complications of anterolateral foraminotomy:

• Nerve damage
• Damage to your spinal cord
• Cerebrospinal fluid leak
• Recurrent disc prolapse or nerve compression
• Quadriplegia (paralysed arms and legs)
• Incontinence (loss of bowel/bladder control)
• Impotence (loss of erections)

There is also a small risk that the surgery won't relieve your pain. This could be down to factors such as your age, location of the compressed nerve in the spinal canal, or any other medical conditions you have.

Prior to the surgery, your consultant will explain everything to you, taking care to address any questions or concerns you might have, so that you can make a completely informed decision.

When you choose to go private with Circle Health Group, you can expect:

• Flexible appointment times and locations to fit your routine
• The ability to decide which hospital and consultant best suits your needs
• Personalised, consultant-led treatment plans tailored to you and your requirements
• Comfortable and safe private facilities maintained by specialist multidisciplinary teams
• Private ensuite rooms as standards and delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

To learn more about anterolateral foraminotomy, book your appointment online today or call a member of our team directly on 0141 300 5009.

Content reviewed by Circle in-house team in January 2023. Next review due January 2026.

1. Cervical Foraminotomy Surgery for Arm Pain Relief, Spine Health
2. What is Cervical Radiculopathy?, Spine Health
3. Foraminotomy, John Hopkins Medicine