A procedural technique that decompresses nerve roots by removing a minimal amount of bone, vertebral disc material, and other spinal abnormalities narrowing the foraminal canal.
What is a Foraminotomy?
- Relieves pressure on spinal nerves compressed by a narrowed foraminal nerve opening.
- The bones, tissues, disc material, or excessive ligament that is obstructing the foraminal canal is removed to decompress the pinched nerves.
- Foraminotomy is sometimes combined with a discectomy or microdiscectomy, which completely or partially removes a herniated or bulging disc. For excessive bone and tissue removal, a foraminectomy may be performed instead. If stability of the spine may be a complication, then spinal fusion may be performed as well.
- Procedure is minimally-invasive.
Foraminotomy is a spinal procedure that alleviates the pressure on spinal nerves by bone, tissues, and other spinal irregularities that are narrowing a set of vertebral foramen. The foramen is openings in the spine where nerve roots leave the spinal column to the various areas of the body. If the foramen becomes narrowed, the nerve roots may become pinched, causing pain and other debilitating symptoms.
Foraminal stenosis may be caused by a variety of spinal conditions, but the most common include degenerative disc disease, a herniated or bulging disc, spondylosis, and facet joint syndrome. Aging, injuries, sudden trauma, repetitive physical activity, wear and tear, and tumors may all cause these various spinal conditions. Abnormal structures in the spinal canal are formed over time and narrow the foraminal canals.
Some patients may have foraminal stenosis for a while before noticing any symptoms. Usually, the first symptom that a patient with this condition experiences is pain of varying strength felt in the lower back, buttocks, and legs, or neck, shoulders, and arms. The pain may be sharp, dull, throbbing, comes and goes, or constant. Foraminal stenosis may affect the patient's quality of life, and requires a foraminotomy if conservative methods of treatment fail to relieve pain.
What does it treat?
- Foraminal Stenosis
- Degenerative Disc Disease
- Herniated or Bulging Discs
- Pinched Nerve
Who are good candidates?
Ideal candidates for a foraminotomy may experience varying symptoms and may have diverse spinal conditions, but most have foraminal stenosis. Candidates should have neck or back pain for at least 3 months and experience one or more of the following symptoms:
- Acute or chronic pain in the neck or back that is dull, deep, constant, shooting, throbbing, sharp, or radiating to the extremities
- Pain that radiates from the lower back to the buttocks, legs, calves, feet, and/or toes
- Pain that radiates from the neck to the shoulders, arms, hands, and/or fingers
- Weakness, numbness, or tingling sensation felt in the muscles and/or the extremities
- Limited motor functions
- Difficulty performing daily activities or partaking in physical activity
- Difficulty standing, walking, or sitting for varying periods of time
- Past failed attempts at relieving pain with conservative methods of treatment
Additionally, ideal candidates should acknowledge the possibility of physical therapy as part of their recovery. Patients should also be optimistic towards successful pain improvement and management.
What is the procedure like?
A foraminotomy usually takes about 1 to 2 hours to complete, depending on the patient's spinal conditions and its complexity. The patient will be under general anesthesia during the procedure.
The following are the general steps of the foraminotomy procedure:
- The procedure begins with the prepping of area on the back or neck for the incision. After creating a small one to three inch incision, the skin, muscles, and tissues are separated so the surgeon can operate.
- A small amount of bone (a laminotomy) may be removed to expose the foraminal canal. Any abnormal spinal structures present like disc material or excessive ligaments are removed to decompress the nerve roots.
- If a herniated or bulging disc is present, then a microdiscectomy or a discectomy may be performed to remove part or most of the disc material. A fusion may also be performed if instability may become an issue.
- The nerves are now decompressed, and the procedure ends when the surgeon closes the incision with sutures.