Foraminotomy

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What is a foraminotomy?

A foraminotomy is a surgical procedure. It enlarges the area around one of the compressed nerves in your spinal column.

Your spinal column is made up of a chain of bones called vertebrae. The intervertebral disks sit above and below the flat portion of each vertebra and act as a cushion.

Your spinal column houses your spinal cord and helps protect it from injury. The spinal cord sends sensory information from the body to the brain. The spinal cord also sends commands from the brain to the body. Nerves spread out from the spinal cord, sending and receiving this information. They exit the spinal column through small holes (intervertebral foramen) that lie between the vertebrae.

Sometimes these openings can become too small. When that happens, the compressed nerve can cause symptoms such as pain, tingling in the arms and legs, and weakness. The exact symptoms depend on the location of the compressed nerve along the spinal column. (For example, a compressed nerve in the neck may lead to neck pain and tingling and weakness in the hand and arm.)

During your foraminotomy, your surgeon will make a cut (incision) on your back or neck and expose the affected vertebra. Then he or she can surgically widen your intervertebral foramen, removing whatever blockages are present.

Why might I need a foraminotomy?

Blockages that narrow the spinal column or block an intervertebral foramen are called spinal stenosis or foraminal stenosis. Various processes can block the intervertebral foramen and compress the nerve leaving the spinal cord. Conditions that can cause spinal stenosis include:

Degenerative arthritis of the spine (spondylosis), which can cause bony spurs
Degeneration of the intervertebral discs, which can cause them to bulge into the foramen
Enlargement of the nearby ligament
Spondylolisthesis
Cysts or tumors
Skeletal disease (like Paget disease)
Congenital problems (like dwarfism)

Degenerative arthritis of the spine (from old age) is one of the most common causes.

This nerve compression can happen along any part of your spinal column. Your compressed nerve may start to cause symptoms, like pain in the affected region and tingling and weakness in the affected limb. You might need a foraminotomy if you’ve already tried other treatments and had no success. This includes physical therapy, pain medicines, and epidural injections.

Usually, your surgeon can do the surgery as an elective procedure to help relieve these symptoms. You might need to have an emergency foraminotomy if your symptoms are quickly getting worse, or if you have problems with your bladder due to your nerve.

What are the risks of a foraminotomy?

Foraminotomy is successful in most people, but complications can occasionally happen. Most of these are rare. Some possible complications include:

Infection
Too much blood loss
Nerve damage
Damage to the spinal cord
Stroke
Complications from anesthesia

There is also a small risk that the procedure will not relieve your pain. Your own risk of complications may vary depending on:

Your age
The location and anatomy of your intervertebral foramen
The type of foraminotomy performed
Your other medical conditions

Ask your provider about the risks that most apply to you.

How do I get ready for a foraminotomy?

Talk to your provider about how to get ready for your surgery. Ask if you should stop taking any medicines ahead of time, like blood thinners. You’ll need to not eat and drink anything after midnight the night before your procedure.

Before your surgery, your provider may order additional imaging tests to get more information about your spinal column and nerves. The most common test in this setting is an MRI.

What happens during a foraminotomy?

Your healthcare provider can help explain the details of your particular surgery. (The following outlines a minimally invasive type of foraminotomy. Incisions are wider in a traditional foraminotomy.) A neurosurgeon and a team of specialized nurses and healthcare providers will perform the surgery. The whole surgery will take a couple of hours. In general, you can expect the following:

During the procedure, you’ll lie on your stomach.
You will be given medicine (anesthesia) to put you to sleep through the surgery. You won’t feel any pain or discomfort during the procedure.
Someone will carefully monitor your vital signs, like your heart rate and blood pressure, during the surgery.
Your surgeon will make a small incision just beside your spine on the side you have your symptoms. He or she will make the incision at the level of your affected vertebra.
Your surgeon will use X-rays and a special microscope to guide the surgery.
Using special tools, your surgeon will push away the back muscles around the spine to expose the blocked intervertebral foramen.
Your surgeon will use small tools to remove the blockage inside the intervertebral foramen. The blockage may be a bone spur or a bulging disk. This will relieve pressure on the nerves.
In some cases, your surgeon might do another procedure at this time, like a laminectomy. This removes part of the vertebra.
The team will remove the tools and put your back muscles back in place. Someone will then close the small incision in your skin.

What happens after a foraminotomy?

Talk to your healthcare provider about what to expect after your foraminotomy. Within a couple of hours, you should be able to sit up in bed. You might have a little pain, but you can have pain medicines to ease the pain. You should be able to eat a normal diet.

You’ll need to move the affected area carefully. You will be told if you should not do any certain movements for a while. (For example, you might need to avoid bending your neck if your foraminotomy was in this region.) You’ll also likely need a soft neck collar if your surgery was in your neck.

You should be able to go home a day or two after your surgery. Be sure to follow all of your provider’s instructions about medicines, physical activity, and wound care. You may need to not do certain movements for a while. You may be able to do light work in a few weeks, but you may need to avoid heavier work for a few months. Some people might need physical therapy as they recover.

Your provider can give you a realistic idea of what to expect after your surgery. Remember to keep all follow-up appointments. Most people will see a real improvement in their symptoms. Be sure to tell your provider if you don’t get better, or if you have new or worsening symptoms.