A foraminotomy is a surgical procedure which is performed for decompressing i.e. removing pressure on a spinal nerve root.
The term comes from the spine’s foramen, which is the hollow nerve passageways, through which your nerve roots exit the spinal column. The procedure is performed in the thoracic spine, cervical spine as well as in the lumbar spine.
Blockages that lead to your spinal column getting narrowed or an intervertebral foramen getting blocked are termed as spinal stenosis. There are various processes which can lead to your intervertebral foramen getting blocked and the nerve getting compressed, leaving the spinal cord.
Conditions that can lead to spinal stenosis include:
- Degeneration of the intervertebral discs, which can cause them to bulge into the foramen
- Cysts or tumors
- Degenerative arthritis of the spine (spondylosis), which can lead to bony spurs
- The nearby ligament getting enlarged
- Skeletal disease
- Congenital problems like dwarfism
Degenerative arthritis of the spine, which comes from old age, is generally the most common cause of spinal stenosis.
This nerve compression might occur along any part of the spinal column. Your compressed nerve might be leading to symptoms, such as pain in the affected region as well as tingling and weakness in your affected limb. A foraminotomy might also be required if you have already tried other treatments but had no success. This can include physical therapy, pain medicines, as well as epidural injections.
Though generally this surgery can be performed as an elective procedure for helping relieve these symptoms, in some cases you might also need to have an emergency foraminotomy if your symptoms get worse quickly or if you are having problems in your bladder caused by your nerves.
Your doctor will provide you instructions regarding getting ready for your surgery. Ask him/her if you will need to stop taking any kind of medications, such as blood thinners. You will also need to avoid food and drink after midnight on the night before the procedure.
Before your surgery, your doctor might also order additional imaging tests for getting more information about your nerves and spinal column. Generally, an MRI is the most common test which is performed.
The procedure is minimally invasive and can be performed at any level of your spine. Before the procedure, general anesthesia is used.
During the surgery, first, you lie down on the operating table. An incision is first made in the middle of the back of your spine. The length of the incision generally depends on how much of your spinal column is going to be operated on. Skin, muscles as well as ligaments are moved to the side. A surgical microscope is required in some cases so that your surgeon can see the back.
Some bone is cut or shaved away for opening the nerve root opening, i.e. foramen. Disk fragments causing the blockage will be removed. If other bone at the back of your spine also requires removal, your surgeon might need to perform any additional procedure such as laminotomy. Then your surgeon might perform a spinal fusion to make sure that your spine is stable after the surgery. Then the muscles and tissues are put back in place, and the skin is sewn together.
Aftercare & recovery
Few hours after the procedure is done, you should be able to sit up in bed. If there is any pain, you can control it with medications. You should also be able to eat a normal diet unless your doctor recommends against it.
Patients are generally able to go home in a day or two following the procedure. Make sure that you follow your doctor’s instructions regarding wound care, physical activity as well as medications. Sometimes people might also need physical therapy after this procedure. After a few weeks, you should be able to perform light work.
Keep your follow-up appointments with your doctor and discuss with him/her about any new worsening symptoms following foraminotomy.
Around 80-90 percent of patients generally benefit from this surgery and are also able to maintain it long term.
Though foraminotomy is successful in most people and there is very minimal risk associated with the procedure, in some rare cases, there might be few complications which can include:
- Nerve damage
- Damage to the spinal cord
- Excess blood loss
- Complication from anesthesia
Other than these complications, there is also a slight risk that your procedure will not relieve your pain. The risk of complications that arise out of the procedure can generally vary from person to person depending on several conditions such as age, anatomical location of the surgery in the spine, the patient’s medical condition, etc.