Foraminotomy

The foramen is the natural passage or tunnel between the vertebrae of the spine through which a nerve root exits from the spinal canal. When this foramen becomes narrowed, the nerve root can become irritated or dysfunctional. Removing bone and soft tissues to enlarge the passage for the nerve is called a foraminotomy. A foraminotomy is commonly performed as part of a decompression of the spinal canal. In some cases a foraminotomy may be performed from outside the canal and not involve any direct decompression of the central canal if the pressure is strictly on the nerve root. To perform this operation, specialized instruments are used to remove portions of bone.

A foraminotomy is a decompression surgery that is performed to enlarge the passageway where a spinal nerve root exits the spinal canal. Foramenotomies are typically performed in conjunction with a laminotomy, laminectomy or microdiscectomy.

During a foraminotomy, the spine surgeon removes bone or tissue that obstructs the passageway and pinches the spinal nerve root, which can cause inflammation and pain. The nerve passageways are called neuroforamen.

Cervical Foraminotomy Procedure.
1. Incision
2. Clear bone and soft tissue to access problem disc
3. Check nerve root freedom
4. Remove pressure on nerve root

The neuroforamen are passageways that are naturally formed on either side between an upper and lower vertebra. In between each upper and lower vertebra is an intervertebral disc. The height of the disc separates the two vertebrae and creates the size of the neuroforamen.

There are 31 pairs of spinal nerve roots that shoot off from the spinal cord and exit the spinal canal through the neuroforamen. Spinal nerve roots branch out to form an intricate network of nerves outside of the spinal canal called the peripheral nervous system.

When the size of a neuroforamen is reduced, there is less room for the spinal nerve, which may cause nerve compression. Symptoms of nerve compression include pain, stiffness, numbness, tingling sensations and weakness.

Since spinal nerves branch outward to form the peripheral nervous system, these symptoms may radiate into other parts of the body. For example, cervical nerve root compression can cause symptoms in the shoulders, arms and hands. Lumbar symptoms may radiate into the lower back, buttocks, legs and feet.

Disorders that can cause nerve root compression include spinal stenosis, degenerative disc disease, a bulging or herniated intervertebral disc, bone spurs and spondylosis. If you have a severe case of one of these conditions, your doctor may recommend a spinal decompression surgery, such as a foraminotomy. Spinal decompression surgery creates more space around the nerve, which may relieve pain. Foraminotomy is often combined with laminotomy and discectomy to decompress nerves.

 

Endoscopic Foraminotomy of the Lumbar and Cervical Spine

Cervical Posterior Forminotomy

Endoscopic foraminotomy is a minimally invasive spine surgery used to relieve pressure caused by compression from bone spurs, disc herniations, scar tissue, or excessive ligament development. With a quick recovery time, foraminotomy surgery patients are often up and back to normal activities quickly.

During a foraminotomy procedure, part of your vertebral bone is removed to gain access to your pain generator. The two foraminotomy procedures (cervical and lumbar) vary slightly and more detail on each can be found below.

Endoscopic Foraminotomy surgery is a true minimally invasive spine surgery that include the following advantages:

  • Minimally invasive
  • Short recovery
  • High success rates
  • Local anesthesia
  • Minimal or no blood loss
  • Preservation of spinal mobility
  • Small incision and Minimal scar tissue formation
  • Same day surgery with no hospitalization (outpatient procedure)

Lumbar Endoscopic Foraminotomy

  • Arthritis of the spine / Bone spurs
  • Bulging disc / Disc herniation
  • Failed back surgery syndrome
  • Foraminal narrowing (foraminal stenosis)
  • Spine degeneration
  • Radiculitis / Radiculopathy
  • Sciatica
  • Spinal slippage (spondylolisthesis)
  • Spinal instability
  • Spinal stenosis

Cervical Endoscopic Foraminotomy

  • Cervical spine degenerative disease with spinal nerve compression
  • Failed previous neck surgery
  • Cervical spinal nerves pinched by disc herniations and bone spurs

During endoscopic foraminotomy surgery, the patient is brought to the operative room. Under anesthesia, a small metal tube is inserted to the neuroforamen for direct visualization. The surgical tools are inserted through this tube so that your muscles do not need to be torn or cut open. The spinal nerve is found under direct visualization  looking through the tube, and protected. Under direct vision, bone spurs, scars, ligament overgrowth, protruded discs, and part of the troubled lumbar facet are removed with appropriate tools (eg, a laser, radiofrequency or mechanical tools) to enlarge the nerve hole and to release the compressed nerve(s). Finally, the tube is removed and the incision is closed with a stitch or two.

 

Who Needs Foraminotomy?

Patients undergo foraminotomy surgery for a number of reasons, the most common being spinal stenosis. A narrowing of the spinal canal, spinal stenosis occurs when the ligaments in the spine thicken or harden to compress the spinal cord and nerves. Spinal stenosis can result from bone spurs, fractures, tumors and even just the normal wear and tear that accompanies the aging process. Some patients may possess a genetic predisposition for spinal stenosis, and the condition is slightly more common in women than in men.

Undergoing Foraminotomy Surgery

Foraminotomy is a surgical procedure to relieve compression by removing the bone and tissue that is pressing on the spinal cord and nerves. Our spine surgery specialists can perform foraminotomy as an endoscopic procedure

During a foraminotomy, the surgeons insert a serious of small dilators (tubes of increasing size) into a one-inch incision in the back. Using this technique allows our spine surgeons to move around the surrounding muscle rather than cutting through it. After the last dilator has been inserted, doctors attach a tube-shaped retractor connected to a clamp. Using a microscope for improved visualization, the surgeon removes the bone or tissue causing the nerve compression.

Typically, foraminotomy surgery takes about an hour. Many patients experience immediate relief after undergoing foraminotomy.

 

Recovery After Foraminotomy

After the procedure, patients can generally go home within an hour or two. Most patients see a profound improvement in their pain levels within three months of having the procedure, and few experience negative side effects related to foraminotomy.

Some patients require physical therapy after foraminotomy. Doctors may also advise patients to wear a neck brace. Following your surgeon’s instructions meticulously can help you achieve a great result after foraminotomy.

Frequently Asked Questions

Q: What are the advantages of an endoscopic foraminotomy?

A: The advantages of endoscopic foraminotomy include a reduced risk of infection, minimal blood less and less scar tissue formation.

Q: When can I start working out after foramintomy?

A: You can resume some activity almost immediately after having foraminotomy. However, you should avoid participating in high-impact sports or exercises for 3-6 months.

Q: Who is a good candidate for foraminotomy?

A: If less invasive treatments are not relieving your spine pain, you may be a good candidate for foraminotomy. Talk to our spine specialists to see if this treatment is right for you.