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Spine Treatments

Cervical Endoscopic Foraminotomy

The prevalence of nerve root compressions in the neck is extremely high, especially among people of working age, and it significantly impacts their quality of life. A large proportion of patients eventually need surgery. A posterior cervical endoscopic foraminotomy is an effective technique that does not limit the range of motion of the cervical spine and minimizes the impact on adjacent tissues.

Cervical endoscopic foraminotomy is an ultra-minimally invasive surgical procedure used to relieve symptoms caused by compression of the nerve roots in the cervical spine. It is often indicated when a patient has radiculopathy—pain that radiates from the neck to the shoulder and arm—caused by nerve root compression. Nerve root compression is commonly due to degenerative changes in the cervical spine, such as herniated discs or bone spurs. Surgical decompression is necessary when conservative treatment fails or when neurological function worsens.

This procedure focuses on enlarging the intervertebral foramen, the bony opening where nerve roots exit the spinal canal. Using endoscopic techniques, Dr. Ball makes a small incision in the back of the neck and uses an endoscope (a specialized camera and instruments) to visualize and perform the surgery with minimal disruption to surrounding tissues. This full endoscopic method is the least invasive in spine surgery. This is a highly technical procedure requiring a surgeon like Dr. Ball, who has extensive experience in microsurgery and endoscopic techniques.

Cervical endoscopic foraminotomy is typically indicated for patients with foraminal stenosis, which is a narrowing of the neural foramen, leading to nerve root compression. This condition may cause neurological symptoms such as pain, numbness, or weakness in the neck, shoulders, arms, and hands. Common underlying causes include degenerative disc disease, herniated discs, bone spurs, or spondylosis, one of the most common degenerative diseases of the spine that is typically treated with surgery.

The procedure is designed to treat nerve root compression that results in radiculopathy (radiating pain), neurogenic claudication (leg pain that worsens with walking), and certain cases of cervical spinal stenosis when conservative treatments like medication, physical therapy, or injections have failed to provide relief. This procedure is an alternative to anterior cervical discectomy and fusion.

The procedure is performed using local anesthetic and sedation or general anesthesia. After making a small incision, Dr. Ball will insert an endoscope, under fluoroscopic X-ray guidance, into the incision to visualize the spine. He will remove a portion of the bone and any soft tissue that is compressing the nerve root using tiny instruments.

The endoscope allows for minimal disruption of the muscles and soft tissues, which allows for a quicker recovery compared to traditional open spine surgery. Once the decompression is achieved, the instruments are withdrawn, and the incision is closed with sutures or surgical staples.

Recovery is quick; patients are typically discharged the same day or the day after surgery. Immediately after surgery, patients typically notice a significant decrease in pain intensity and improve after that.

Rehabilitation involves a gradual return to activities, physical therapy to strengthen the neck and restore flexibility and function, and restrictions of heavy lifting post-surgery.

Cervical endoscopic foraminotomy offers a significant reduction in symptoms related to nerve compression. However, like any surgical procedure, it carries risks such as infection, bleeding, or the potential for persistent symptoms if nerve damage was severe or longstanding before surgery. The decision to proceed with surgical intervention will be based on a thorough discussion between you and Dr. Ball, who will discuss the benefits and risks so you can make an informed treatment decision.

Contact Dr. Hieu Ball to schedule a consultation at his San Ramon. He offers a full range of treatments for neck pain. Dr. Ball offers state-of-the-art patient-centered care for patients with neck, mid-back, and low-back problems. He received his orthopedic and spine surgery residency and fellowship training at Harvard Medical School and UCLA-affiliated institutions. Education included training at Massachusetts General Hospital, Brigham and Women’s Hospital, and Boston Children’s Hospital. Dr. Ball is a double fellowship-trained orthopedic spine surgeon. He received a pediatric spine fellowship at Boston Children’s Hospital and a second adult spine fellowship at UCLA. Dr. Ball offers minimally invasive spine care, and many procedures often may be performed on an outpatient basis in an ambulatory surgical center setting.


  • Olson TE, Upfill-Brown A, Young Park D, Endoscopic posterior cervical foraminotomy techniques and outcomes, Seminars in Spine Surgery, Volume 36, Issue 1,2024,101086,
  • ISSN 1040-7383, https://doi.org/10.1016/j.semss.2024.101086.
  • (https://www.sciencedirect.com/science/article/pii/S1040738324000091)
  • Gatam AR, Gatam L, et al. Full Endoscopic Posterior Cervical Foraminotomy in Management of Foraminal Disc Herniation and Foraminal Stenosis. Orthop Res Rev. 2022 Jan 17;14:1-7. Doi: 10.2147/ORR.S349701. PMID: 35125894; PMCID: PMC8812322.
At a Glance

Dr. Hieu Ball

  • Double fellowship-trained orthopedic
  • Orthopedic surgery residency at Harvard Medical School
  • Over 20 years of spine surgery experience
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