Foraminotomy Spine Surgery
Foraminotomy is a type of spine surgery performed to relieve pressure on a spinal nerve root. Nerves exit the spinal cord through small passages, called the neuroforamina. These passages can become narrowed due to aging or injury, putting pressure on the nerve and causing pain. A foraminotomy enlarges a neuroforamen, often by removing material causing the constriction, to relieve that pressure.
Depending on the location of the compressed nerve or severity of symptoms, foraminotomy may be combined with other procedures that involve complete or partial removal of the lamina. The lamina is a bony structure that exists in pairs on each set of two vertebrae. The laminae protect the back of the spinal cord, but they are vulnerable to age-related degeneration. Removing some or all of a lamina may provide greater access to the foramen.
As part of a foraminotomy, your spine surgeon may recommend one of the following:
- Laminectomy is the removal of the entire lamina, a portion of the enlarged facet joints, and the thickened ligaments overlying the spinal cord and nerves.
- Laminotomy is the removal of a small portion of the lamina and ligaments, usually on one side. Using this method, the natural support of the lamina is left in place, decreasing the chance of postoperative spinal instability. Sometimes an endoscope may be used, allowing for a smaller, less invasive incision.
Foraminotomy is classified as a decompression spine surgery. The Denver spine surgeons at Neurosurgery One (formerly South Denver Neurosurgery), can perform minimally invasive foraminotomy for most patients, which helps reduce post-surgical pain and can help speed recovery.
What Conditions Can Foraminotomy Treat?
Foraminotomy is used to treat a condition known as spinal stenosis. Spinal stenosis can occur in any part of the back or neck. Spinal stenosis occurs when the neuroforaminal passages become narrowed, either through constriction or a blockage.
There are a number of processes and conditions that can cause spinal stenosis, including:
- Osteoarthritis of the spine (spondylosis), which can cause bony spurs that block the passageway
- Degeneration of the discs, which can cause them to bulge into the foramen
- Enlargement of a nearby ligament into the foramen
- Spondylolisthesis, a condition in which a vertebra slips forward onto the bone directly beneath it.
- Cysts or tumors
How Is Foraminotomy Performed?
A foraminotomy is a type of spine surgery known as decompression, because it is done to create more space in the spinal canal in order to relieve pressure. A foraminotomy involves an incision through the skin to reach the spine. During foraminotomy, one of our expert Denver spine surgeons will remove bone, discs, or other tissue obstructing the passageway where a spinal nerve root exits the spinal canal. This enlarges the intervertebral foramen and relieves pressure.
At Neurosurgery One, our spine neurosurgeons are able to offer many patients the option of foraminotomy performed in a minimally invasive procedure. For those who are candidates, minimally invasive foraminotomy spine surgery provides benefits including:
- Smaller incision
- Shorter surgical time
- Less blood loss
- Less muscle damage
- Reduced risk of infection
- Less post-surgical pain
- Faster recovery
Who is a Candidate for Foraminotomy?
Foraminotomy surgery for spinal stenosis generally is only considered when more conservative therapies such as steroid injections and physical therapy fail to provide adequate pain relief.
Candidates for foraminotomy are those who experience:
- Neck or back pain for at least three months
- Acute or chronic pain that is dull, deep, constant, shooting, throbbing, sharp,
- Pain that radiates to arms and legs
- Weakness, numbness, or tingling in the muscles or extremities
- Decreased motor functions
- Difficulty performing daily activities or physical activity due to pain
- Difficulty standing, walking, or sitting for long periods of time
In addition, at Neurosurgery One, our Denver spine surgeons believe that surgery should be performed only when patients have a diagnosis of compressed nerves, or spinal stenosis, that is confirmed through imaging such as MRI.
Benefits of Foraminotomy Surgery
Studies show that pain and other symptoms improve in more than 90 percent of patients who undergo foraminotomy for spinal stenosis conditions. Symptoms such as tingling may disappear immediately, while others, including numbness and weakness, may take longer to resolve.
Risks of Foraminotomy
All surgical procedures carry some risk, including minor risk of:
In addition, risks associated with foraminotomy spine surgery include:
- Small risk of injury to the nerve or spinal cord.
- For fewer than 10 percent of patients, foraminotomy may not relieve all pain.
- A 4 percent chance or less of complication.
- A 6 percent risk or less of the condition recurring.
Recovery from Foraminotomy
Because foraminotomy surgery is most often performed as a minimally invasive procedure, patients can expect, on average, shorter hospital stays. While some may go home the same day, the majority remain in the hospital overnight.
Patients are advised to avoid lifting anything heavier than five to 10 pounds during the first six weeks after the procedure. Typically, patients can return to work and regular activities, with lifting restrictions, within a couple of weeks after spine surgery.
Pain from the spine surgery is generally well tolerated and controlled with over-the-counter pain relievers, such as ibuprofen. Pain usually dissipates within one to two weeks.