A foraminotomy is a back surgery procedure used to enlarge the opening through which a spinal nerve passes as it exits the spinal canal. These openings in between the vertebrae are called neuroforamen. Other common nomenclature for the structures includes foraminal spaces, foraminal openings or simply foramen.
When these openings are reduced due to spinal degeneration or injury, there is less room for the nerves to pass between the bones. These structural changes sometimes cause a pinched nerve and the usual unsettling symptoms, including pain, tingling, numbness and/or weakness.
This essay profiles surgical interventions that can increase the patency of the neuroforaminal openings to allow unimpeded egress of nerve tissues.
Foraminotomy Procedures
The surgeon will have many procedural options from which to choose while enacting foraminal enlargement. The operation was traditionally a full open surgery which was performed under general anesthesia. This would include a large spinal incision, muscle dissection and possible laminectomy, to remove additional bone.
If the surgeon is trained in minimally invasive foraminotomy procedures, then the operation can be done with an endoscope. This will save the patient much recovery time, pain and damage to healthy tissue. The surgeon will access the problem area and use sophisticated tools to carefully enlarge the neuroforamen, thereby decompressing the spinal nerve root. When the foraminal opening is large enough to once again allow healthy nerve signal, the surgeon will close the incision.
Some foraminal procedures are now completed using the innovative anterior approach. This saves the patient from any disturbance to the sensitive back muscle anatomy. Healing time is further improved and post-operative discomfort reduced over other types of minimally invasive approaches.
Foraminal Enlargement Indications
There are many causative conditions that can be treated successfully with a foraminotomy procedure. Sometimes, additional surgical techniques will be used in tandem to address an assortment of pathological contributors to the stenosis condition.
Many spinal conditions can create narrow neuroforamen, which can cause pain and other neurological back pain symptoms. Some of the most common of these diagnoses include osteoarthritis, intervertebral disc pathologies and facet joint syndrome.
It must be noted that this surgical technique is often added to other procedures, such as laminectomy, corpectomy or spinal fusion surgery, when the origin of foraminal space narrowing is caused by some type of abnormal spinal curvature, like kyphosis or lordosis, as well as when the causative mechanism is a vertebral misalignment issue, like retrolisthesis or anterolisthesis.
However, foraminal enlargement techniques are most commonly used in combination with discectomy procedures for resolving intervertebral-related narrowing.
Recovery from Foramen Surgery
The minimally invasive form of the procedure will require the patient to remain hospitalized for a few hours, while the full open version requires a stay of a few days. Obviously, minimally invasive back surgery will have the patient up and around faster, making it a preferable choice.
The patient will have to take it easy for a few weeks and be satisfied with only limited physical activity. Physical therapy is common to help the patient regain full range of motion. It is crucial that postoperative patients follow aftercare instructions to the letter to minimize their chances for infection and other common and potentially serious complications.
Foraminotomy Risks
As with all surgical procedures, there is risk from both the procedure and the anesthetic. Infection, bleeding, spinal fluid leak or possible nerve damage are all surgical complications associated with this procedure. Make sure you know and understand all the risks before making a decision to undergo treatment.
If your surgeon does not inform you of the risk factors in advance, be sure to bring these up in conversation. Do not let any doctor make your feel foolish for inquiring about the potential health risks of any surgical procedure.
Also, do not let any doctor downplay the risks of minimally invasive techniques. Any procedure which enters the body can enact significant health consequences, including chronic pain, lasting anatomical injury or even death.
Results of Foraminotomy
Foramen enlargement is used far more often than is necessary. The nerve roots do not need a huge space to pass through and minor to moderate decreases in neuroforaminal size are completely normal and expected to experience as we get older.
Degenerated discs are normal for people as they age, as is spinal arthritis. Both of these conditions will result in smaller neuroforamen. However, most people do not experience pain from these normal conditions.
Most quality doctors advise avoiding back surgery, unless the situation is dire and an operation is the only possible solution. If it is your last resort, make sure to choose a surgeon who will use a minimally invasive procedure if at all possible.
Pinched nerves are one of the most often misdiagnosed of all back ache sources. In a great number of cases, there is foraminal encroachment and maybe even nerve contact or displacement. However, unless the nerve is actually compressed, there is not likely to be any symptoms or only mild and transitory symptoms. This helps to explain the poor treatment results offered to many patients. If there is any doubt as to the validity of the diagnostic theory, wait for surgery until more definitive evidence can be produced.
Remember also that for many conditions which are actually causing a compressive neuropathy, nonsurgical care offered by techniques like spinal decompression may resolve the structural issue and allow the patient to find a cure without surgical intervention. This is always a less risky and much preferred path of treatment.
