What is Foraminotomy surgery?
In addition to vertebrae and discs, the spinal column contains many foramina, holes through which the ne
rves pass from the spinal canal to the rest of the body. When a foramen narrows, a condition known as foraminal stenosis, the adjacent nerve may be impinged upon, causing irritation and dysfunction. In order to alleviate this condition, a foraminotomy, a surgical procedure to clean out the foraminal passage, may be performed. During a foraminotomy, bone and soft tissues is removed to widen the foramen and decompress the affected nerve. A foraminotomy can be performed at any level of the spine, but is most commonly performed in the cervical or lumbar region.
Am I a Candidate for a Foraminotomy?
When a patient has foraminal stenosis, narrowing of the openings for the nerve roots to exit the spinal canal, Dr. Girardi exhausts conservative treatment options prior to moving to surgery. In these cases, patients can often be effectively treated with anti-inflammatory medications, corticosteroid injections, physical therapy, or by using a neck brace to immobilize the spine. There are cases when early surgery is recommended, however. If the nerve compression is severe and causing extreme weakness in the arm, early surgery may be necessary. The same is true if the arm pain is so severe that it isn’t responding to available pain medication. When a herniated disc is the cause of the compression, a cervical foraminotomy may not be the best operation. Instead a microdiscectomy is a better procedure. When the focus is on removing part of the bone to provide more room for the nerve root, a foram
inotomy is called for. But there can be overlap between the procedures when it comes to dealing with a protruding cervical disc. Surgery usually becomes a viable option when conservative treatments have not made improvements after six weeks.
A foraminotomy is not normally considered unless the foraminal stenosis does not respond to conservative treatments.
Non-Surgical Foraminotomy Treatment Options
While cervical foraminotomy is a successful procedure in the majority of cases, most patients can get better without surgery. These are conservative treatments that will be tried first:
- Analgesia with NSAIDs
- Analgesia with other medications
- Perineural steroid and local anesthetic injections
Is Anesthesia Needed for a Foraminotomy?
Dr. Girardi performs minimally invasive cervical foraminotomy whenever possible. This allows this procedure to be done on an outpatient basis. Still, the patient needs to be under general anesthesia.
A foraminotomy is performed under general anesthesia, usually with the assistance of a surgical microscope to delineate the site. Intrusive bone and disc fragments are removed. Frequently, a portion of the lamina, the bony covering of the spinal cord, is also removed, a procedure known as a laminotomy. In some cases, a spinal fusion is performed during the same operation in order to stabilize the spinal column.
While a foraminotomy is a relatively safe procedure, like any surgery it carries risks of excessive bleeding, postsurgical infection, development of clots and adverse reactions to anesthesia or medication. Although these complications rarely occur, they must be considered prior to the operation. With spinal surgery, there is also a minimal danger that the patient will suffer neurological damage or will have a recurrence of back pain.
Recovery from a Foraminotomy
Typically, patients leave the hospital the day after undergoing surgery, but for at least 2 weeks their activities are restricted. During early recovery, they have to refrain from driving, heavy lifting, bending, strenuous exercise and sexual activity. After about 4 weeks, they are normally permitted to resume a light work schedule. For some patients, a collar or brace may be necessary for spinal support as healing takes place. Physical therapy is usually recommended so that patients can regain strength and mobility.
The likelihood of a good/excellent outcome for this procedure is from 85-90 percent. In roughly 10 percent of cases, the procedure doesn’t fully relieve the arm pain. Numbness from the compression is slow to fully resolve, and it may persist. If you’ve had arm weakness, it can take from 6-12 weeks to return to normal. The tingling/pins and needles feeling in your arm and hands usually resolves immediately with this surgery.