Foraminotomy

What is a foraminotomy?

A foraminotomy is a surgical procedure. It enlarges the area around one of the compressed nerves in your spinal column.

Your spinal column is made up of a chain of bones called vertebrae. The intervertebral disks sit in between vertebra and act as a cushion.

Your spinal column houses your spinal cord and helps protect it from injury. The spinal cord sends sensory information from the body to the brain. The spinal cord also sends motor commands from the brain to the body. Nerves spread out from the spinal cord. They send and receive this information. They exit the spinal column through small holes (intervertebral foramen) that lie between the vertebrae.

Sometimes these openings can become too small. When that happens, the compressed nerve can cause symptoms such as pain, tingling in the arms and legs, and weakness. The exact symptoms depend on the location of the compressed nerve along the spinal column. For example, a compressed nerve in the neck may lead to neck pain and tingling and weakness in the hand and arm.

During your foraminotomy, your surgeon will make a cut (incision) on your back or neck. This will expose the affected vertebra. Then they can surgically widen your intervertebral foramen and remove whatever blockages are present.

Why might I need a foraminotomy?

Blockages that narrow the spinal column or block an intervertebral foramen are called spinal stenosis or foraminal stenosis. Various processes can block the intervertebral foramen and compress the nerve leaving the spinal cord. Conditions that can cause spinal stenosis include:

• Degenerative disease of the spine (spondylosis). This can cause bony spurs.

• Degeneration of the intervertebral disks. This can cause them to bulge into the foramen.

• Enlargement of the nearby ligament

• Slippage of one vertebra over another (spondylolisthesis)

• Cysts or tumors

• Skeletal disease, such as Paget disease

• Congenital problems, such as dwarfism

Degenerative disease of the spine (from old age) is the most common cause.

This nerve compression can happen along any part of your spinal column. Your compressed nerve may start to cause symptoms. This includes pain in the affected part and tingling and weakness in the affected limb. You might need a foraminotomy if you’ve already tried other treatments and had no success. This includes physical therapy, chiropractor care, pain medicines, and epidural steroid injections.

Your surgeon can often do the surgery as an elective procedure to help relieve these symptoms. You might need to have an emergency foraminotomy if your symptoms are quickly getting worse. Or if you have problems with your bladder due to your nerve.

What are the risks of a foraminotomy?

Foraminotomy is successful in most people. But complications can occasionally happen. Most of these are rare. Some possible complications include:

• Infection

• Too much blood loss

• Nerve damage

• Damage to the spinal cord

• Stroke

• Complications from anesthesia

• Symptoms and signs that fail to improve

• The need for more surgery

There is a small risk that the procedure will not relieve your pain. Be certain to talk with your surgeon about your pain relief expectations. It's important that you understand the probable outcome related to pain relief in your situation. Your own risk of complications may vary depending on:

• Your age

• The location and anatomy of your intervertebral foramen

• The type of foraminotomy performed

• Your other medical conditions

Ask your healthcare provider about the risks that most apply to you.

How do I get ready for a foraminotomy?

Talk to your healthcare provider about how to get ready for your surgery. Ask if you should stop taking any medicines ahead of time, like blood thinners. You’ll need to not eat and drink anything after midnight the night before your procedure.

You will be asked to sign a document called an informed consent. Your signature on this form gives the surgeon permission to do the surgery. It also states that you understand the risks, benefits, and other choices to your surgery, and that you have had all of your questions answered satisfactorily. Before you sign, make certain you have asked all your questions and are ready to proceed.

Before your surgery, your provider may order additional imaging tests to get more information about your spinal column and nerves. The most common test in this setting is an MRI.

What happens during a foraminotomy?

Your healthcare provider can help explain the details of your particular surgery. The following outlines a minimally invasive type of foraminotomy. Incisions are wider in a traditional foraminotomy. A neurosurgeon and a team of specialized nurses and healthcare providers will perform the surgery. The whole surgery will take a couple hours. In general, you can expect the following:

• During the procedure, you’ll lie on your stomach.

• You will be given medicine (anesthesia) to put you to sleep through the surgery. You won’t feel any pain or discomfort during the procedure.

• Someone will carefully watch your heart rate, blood pressure and other vital signs during the surgery.

• You may be given local anesthesia to the area.

• Your surgeon will make a small incision just beside your spine on the side you have your symptoms. They will make the incision at the level of your affected vertebra.

• Your surgeon will use X-rays and surgical loops or a special microscope to guide the surgery.

• Using special tools, your surgeon will push away the back muscles around the spine to expose the blocked intervertebral foramen.

• Your surgeon will use small tools to remove the blockage inside the intervertebral foramen. The blockage may be a bone spur or a bulging disk. This will relieve pressure on the nerves.

• In some cases, your surgeon might do another procedure at this time, like a laminectomy or laminotomy. This removes part of the vertebra.

• The team will remove the tools and put your back muscles back in place. Someone will then close the small incision in your skin.

What happens after a foraminotomy?

Talk to your healthcare provider about what to expect after your foraminotomy. Within a couple of hours, you should be able to sit up in bed. You might have a little pain, but you can have pain medicines to ease the pain. You should be able to eat a normal diet.

You’ll need to move the affected area carefully. You will be told if you should not do any certain movements for a while. For example, you might need to prevent bending your neck if your foraminotomy was in this region. You’ll also likely need a soft neck collar if your surgery was in your neck.

You should be able to go home a day or two after your surgery. Be sure to follow all your provider’s instructions about medicines, physical activity, and wound care. You may need to not do certain movements for a while. You may be able to do light work in a few weeks. But you may need to stay away from heavier work for a few months. Some people might need physical therapy as they recover.

Your provider can give you a realistic idea of what to expect after your surgery. Remember to keep all follow-up appointments. Most people will see a real improvement in their symptoms. Be sure to tell your provider if you don’t get better. Or if you have new symptoms or some that get worse.

Next steps

Before you agree to the test or procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure