Foraminotomy

The foraminotomy procedure is used to relieve the pain related to a compressed spinal nerve. Back pain and radiculopathy (nerve compression symptoms) are common problems associated with injury and aging. When a patient fails on conservative treatment, a foraminotomy is considered.

What Causes Spinal Nerve Compression?

Nerves of the spine may become compressed for several reasons. Diseases of the spine that lead to nerve root compression include degenerative disc disease, spinal stenosis, facet joint arthritis, and spondylolisthesis. The symptoms of nerve compression are local and radiating pain and numbness, weakness, and tingling in an arm or leg. With foraminal stenosis, the small, passageways on both sides of the vertebrae (foramina) are narrowed. Because the spinal cord and nerves pass through these passageways, nerve compression can occur.

Forainotomy: Relief of Symptoms of Foraminal Stenosis

Compression of a nerve root occurs as a result of degenerative changes in the spine. This damage occurs from repeated strains and stress, which cause one or more spinal discs to collapse. The nerve root is squeezed in the foramen, and the facet joint lining becomes inflamed and enlarged. With a foraminotomy, the surgeon removes excess bone spurs and tissues around the edges of the foramen, which widens the opening and removes pressure from the nerve root.

Preparing for a Foraminotomy?

Before considering surgery, the surgeon will meet with you for an assessment. After asking questions, and taking a medical history, the doctor performs a physical examination. In addition, certain diagnostic tests are used to assess the spine. You will need to notify the doctor of any and all allergies you have, such as allergy to latex.

Because of risk for bleeding, certain blood thinning agents must be held for several days before the procedure. You should not eat or drink after midnight the night before the surgery, and only take required medicines with small sips of water.

How is the Foraminotomy Performed?

With the foraminotomy procedure, an incision is made over the damaged vertebrae. The size of this incision depends on how much damage exists. The surgeon inserts a small retractor to separate the muscles so he can view the foramen and other structures.

A specially designed laser uses pulses of energy to remove bone spurs and disc herniations, which releases pressure on the pinched nerve or nerves. The surgeon will also use a small drill to enlarge the hole where the nerve passes. After all repairs are made, the incision is closed using staples or sutures.

Foraminotomy Recovery

Immediately after the procedure, you are monitored in the recovery room for 60-75 minutes. Once stable, you are moved to a room. A physical therapist works with you to teach you how to use an assistive device (crutches, walker, or cane), and how to get in and out of bed and a chair.

Once you are home, you will continue working with the physical therapist to gradually improve on strength and flexibility. With the minimally invasive keyhole laser foraminotomy, patients can get back to activities of daily living within 1-2 weeks.

How Effective is a Foraminotomy?

In a recent study, researchers evaluated patients who underwent a posterior cervical foraminotomy. Patients were followed for 14 months after surgery. Improvement was observed in 98% of patients, with excellent outcomes reported regarding symptom relief.

Resources

Branch BC, Hilton DL, & Watts C (2015). Minimally invasive tubular access for posterior cervical foraminotomy. Surg Neurol Int, 6, 81.