A Foraminotomy, traditionally performed in a hospital setting, is normally a fairly invasive procedure that requires the repositioning of tissues and cutting of bone to alleviate pressure on the nerve. The recovery time for a traditional foraminotomy is slow and steady, with patients driving a car and performing light physical activities after 8 weeks and a full recovery within 18 months.
We have developed an advanced Foraminotomy surgery, Laser Disc Repair, for relieving pressure on nerves in the foramen that is not only minimally invasive, but requires zero bone cutting. In fact, our procedure is so effective that this is an out patient surgery and most of our patients go back to work in less than 3 days! This is a fraction of the recovery time traditional Foraminotomy patients experience.
A foraminotomy is a surgical procedure. It enlarges the area around one of the bones in your spinal column. The surgery relieves pressure on compressed nerves.
Your spinal column is made up of a chain of bones called vertebrae. The intervertebral discs sit above and below the flat portion of each vertebra to provide support.
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 commands from the brain to the body. Nerves spread out from the spinal cord, sending and receiving this information. They exit the spinal column through a small hole (intervertebral foramen) that lies 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 depends 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 and expose the affected vertebra. Then he or she can surgically widen your intervertebral foramen, removing whatever blockages are present.
A bundle of nerves (nerve root) leaves your spinal cord through openings in your spinal column. These openings are called the neural foramens. When the openings for the nerve root become narrow, it can 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. Symptoms include:
According to a 2015 study, about 84 percent Trusted Source of those who went through a microdiscectomy procedure had long-term success in the treatment of the herniated disc.
Sciatica is a pain condition caused by compression of the spinal nerve. This compression is most often the result of a herniated lumbar disc.
As the hernia develops and the damaged tissue extends into the spinal column, it pushes on the nerves. This causes the nerves to send pain signals to the brain. The pain is interpreted to be coming from the legs.
Most cases of sciatica will heal naturally without surgery in a few weeks. If the pain from sciatica lasts more than 12 weeks, you may benefit from a microdiscectomy.
A microdiscectomy is not effective in relieving back pain.
Foraminal stenosis surgery is performed to remove a small piece of bone and/or tissue putting pressure on the nerve and causing symptoms. The symptoms that can be relieved by a foraminotomy procedure include:
Conditions that can be treated using minimally invasive foraminal stenosis surgery are:
Risks of anesthesia and surgery in general are:
Diagnosis of diseases and disorders of the spine begins with a thorough review of the patient’s health history and a physical exam. The neurosurgeon will ask questions to understand symptoms and when they started. He or she will evaluate the patient’s level of pain, reflexes, muscle strength, range of motion, and reactions to sensory stimulus. Diagnostic tests may include the following:
Laboratory tests to rule out metabolic abnormalities
X-Rays use electromagnetic energy beams to produce images of tissues, bones, and organs, and are performed to diagnose tumors or bone injuries.
Myelogram (myelography) is a diagnostic imaging procedure which combines the use of an injected contrast substance with X-rays or computed tomography (CT) to evaluate abnormalities of the spinal canal, the spinal cord, nerve roots, and other tissues.
Magnetic Resonance Imaging (MRI) is a diagnostic imaging procedure that combines the use of a large magnet, radio frequencies, and a computer to produce detailed images of soft tissues within the body. Bones do not obscure the images.
Computed Tomography (CT or CAT Scan) is a diagnostic imaging procedure that combines the use of X-rays and computer technology to produce many different views (slices) of the same body part. The images provide detailed views of bones and soft tissues.
Nerve Conduction Velocity (NCV) studies can detect problems with nerves, and are often used along with EMG to differentiate a nerve disorder from a muscle disorder.
Electromyography (EMG) is used to detect diseases stemming from problems with the muscle itself, and is often used with NCV to differentiate a muscle disorder from a nerve disorder.
Inform to doctor, what medicines you are taking. This includes medicines, supplements, or herbs you bought without a prescription.
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.
For the one week before surgery, you may be asked to stop taking blood thinners. Some of these drugs are aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn).
If you have diabetes, heart disease, or other medical problems, your surgeon will ask you to see your regular doctor.
Talk with your surgeon if you have been drinking a lot of alcohol.
Ask your surgeon which medicines you should still take on the day of the surgery.
Let your surgeon know right away if you get a cold, flu, fever, herpes breakout, or other illnesses.
You may want to visit a physical therapist to learn exercises to do before surgery and to practice using crutches.
You will likely be asked not to drink or eat anything for 6 to 12 hours before the procedure.
Take the medicines your surgeon 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.
Arrive at the hospital on time.
Your doctor 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 professionals will perform the surgery. The whole surgery will take a couple of 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 monitor your vital signs, like your heart rate and blood pressure, during the surgery.
Your surgeon will make a small incision just beside your spine on the side you have your symptoms. He or she will make the incision at the level of your affected vertebra.
Your surgeon will use X-rays and 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 disc. This will relieve pressure on the nerves.
In some cases, your surgeon might do another procedure at this time, like a laminectomy. 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.
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 need to avoid any certain movements for a while. (For example, you might need to avoid 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 of your provider’s instructions about medicines, physical activity, and wound care. You may need to avoid certain movements for a while. You may be able to do light work in a few weeks, but you may need to avoid heavier work for a few months. Some people might need physical therapy as they recover.
Your doctor 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 or worsening symptoms.
Q. Is Foraminotomy a major surgery?
A. In traditional spine surgery settings, a Foraminotomy is a major open back surgery meant to treat foraminal narrowing which requires an incision the length of the desired operable area in order to access each vertebral level experiencing compression of the nerves.
Q. How long does Foraminotomy surgery take?
A. The procedure will take about 2 hours. For a minimally invasive type of foraminotomy you can expect: During the procedure, you’ll lie on your stomach. You will get anesthesia to help you sleep through the surgery.
Q. How painful is a Foraminotomy?
A. You won’t feel any pain or discomfort during the procedure. Someone will carefully monitor your vital signs, like your heart rate and blood pressure, during the surgery. Your surgeon will make a small incision just beside your spine on the side you have your symptoms.
Q. How successful is a Foraminotomy?
A. The success rates reported for open paraspinal foraminotomy are as high as 99% to 95%and this technique has been considered the gold standard for the surgical treatment of lumbar foraminal or far lateral stenosis.
Q. What is the difference between laminectomy and Foraminotomy?
A. Laminectomy is the removal of the entire bony lamina, a portion of the enlarged facet joints, and the thickened ligaments overlying the spinal cord and nerves. Foraminotomy is the removal of bone around the neural foramen – the canal where the nerve root exits the spine.