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Foraminotomy

Definition

Foraminotomy is surgery that widens the opening in your back where nerve roots leave your spinal canal. You may have a narrowing of the nerve opening (foraminal stenosis).

Alternative Names

Intervertebral foramina; Spine surgery - foraminotomy

Description

Foraminotomy takes pressure off of a nerve in your spinal column and allows it to move more easily. It may be performed on any level of the spine. You will be asleep and feel no pain (general anesthesia).

• You will lie face down on the operating table. A cut (incision) is made in the middle of the back of your spine. The length of the incision depends on how much of your spinal column will be operated on.
• Skin, muscles, and ligaments are moved to the side. Your surgeon may use a surgical microscope to see inside your back.
• Some bone is cut or shaved away to open the nerve root opening (foramen). Any disk fragments are removed. Other bone may also be removed at the back of the vertebrae to make more room.
• If your surgeon is worried that your spine will not be stable after the bone has been removed, you may also need to have spinal fusion.
• The muscles and other tissues are put back in place, and the skin is sewn together.

Why the Procedure Is Performed

A bundle of nerves (nerve root) leaves your spinal cord through openings in your spinal column, called the neural foramen. When the openings for the nerve root become narrow, it may put pressure on your nerve. This condition is called foraminal spinal stenosis.

This surgery may be considered if you have severe symptoms that interfere with your daily life. Such symptoms include:

• Pain that may be felt in your thigh, calf, lower back, shoulder, arms or hands. It is often deep and steady
• Pain when doing certain activities or moving your body a certain way
• Numbness, tingling, and muscle weakness

You will have an MRI to make sure foraminal stenosis is causing your symptoms.

You and your doctor can decide when you need to have surgery for these symptoms. Spinal stenosis symptoms often become worse over time, but this may happen very slowly.

Risks

Risks for any anesthesia are:

• Reactions to medications
• Breathing problems

Risks for any surgery are:

• Bleeding
• Infection in wound or for vertebral bones
• Damage to a spinal nerve, causing weakness, pain, or loss of feeling
• Partial or no relief of pain after surgery
• A return of back pain in the future
• Thrombophlebitis

Before the Procedure

Always tell your doctor or nurse what drugs you are taking, even drugs or herbs you bought without a prescription.

During the days before the surgery:

• Prepare your home for when you leave the hospital after surgery.
• If you are a smoker, you need to stop. Your recovery will be slower and possibly not as good if you continue to smoke. Ask your doctor for help.
• Two weeks before surgery, your doctor or nurse may ask you to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and other drugs like these.
• If you have diabetes, heart disease, or other medical problems, your surgeon will ask you to see your regular doctor.
• Talk with your doctor if you have been drinking a lot of alcohol.
• Ask your doctor which drugs you should still take on the day of the surgery.
• Always let your doctor know about any cold, flu, fever, herpes breakout, or other illnesses you may have.
• You may want to visit a physical therapist to learn some exercises to do before surgery and to practice using crutches.

On the day of the surgery:

• You will usually be asked not to drink or eat anything for 6 to 12 hours before the procedure.
• Take your drugs your doctor told you to take with a small sip of water.
• Bring your cane, walker, or wheelchair if you have one already. Also bring shoes with flat, nonskid soles.
• Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

You will probably be wearing a soft neck collar afterwards if the surgery was on your neck. Most people are able to get out of bed and sit up within 2 hours after surgery. You will need to move your neck carefully.

You should be able to leave the hospital the day after the surgery. You should be able to drive within a week or 2 and get back to light work after 4 weeks.

Outlook (Prognosis)

Foraminotomy for spinal foraminal stenosis will often provide full or partial relief of symptoms.

Future spine problems are possible for all patients after spine surgery. If you had spinal fusion and laminectomy, the spinal column above and below the fusion are more likely to have problems in the future. Also, if you needed more than one kind of back surgery (such as foraminotomy and spinal fusion), you may have more of a chance of future problems.

References

Curlee PM. Other disorders of the spine. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 41.

Park AL. Lower back pain and disorders intervertebral discs. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 39.

Weinstein JN, Tosteson TD, Lurie JD,et al. Surgical versusnonoperative treatment for lumbar spinal stenosis four-year results of the Spine

Patient Outcomes Research Trial. Spine (Phila Pa 1976). 2010 Jun

15;35(14):1329-38.