What is a foraminotomy?
A foraminotomy is a surgical procedure designed to relieve nerve compression causing pain and numbness in the back and extremities. Nerve root compression is addressed by enlarging the foraminal canal. The procedure is only be performed to correct nerve compression caused by the intervertebral foramina.
Understanding the Structures Involved
A foramen is a passage or tunnel which passes our spinal nerves from the spinal cord, through the vertebrae and out into our body. These nerves travel throughout the body providing sensation and other necessary function to their respective areas. The human spine is comprised of 33 vertebrae, between each vertebral pairing is a foramen; 31 different pairs of spinal nerve roots pass through these foramen. Compression in the foramen could be caused by a bone spur, excessive ligament growth, scar tissue, or a damaged intervertebral disc. The result is one of the nerves become pinched, causing the patients pain and numbness.
Foraminotomy Surgery – The Technique
Foraminotomy surgery is most often performed as a minimally invasive technique either microscopically or endoscopically. In a cervical foraminotomy a small incision of 2 – 4 cm is made in the neck; either the anterior or posterior (front or back). For a lumbar foraminotomy the incision is made in the lower back, most often posterior. Once the incision is made the operating surgeon will peel or push the muscle away to gain access to the bone underneath where a small hole will be cut or drilled in the vertebra. At this point the surgeon will be able to visualize the foramen with the aid of microscopic lenses, an arthroscope, or an endoscope and remove the offending material. As well as removing the bone or ligament material, if there is identified disc issues they would also be corrected; if material is removed a laser is usually used to cauterize the disc. Once this material is removed the patient should begin to feel relief of their symptoms. Although many patients will feel immediate relief, it may take several weeks for others.
If the surgeon is satisfied that the foraminotomy surgery has created enough space around the nerve to relieve the compression, the muscles that were peeled or moved out of the way are placed back into position using absorbable sutures. Sutures or staples will be used to close the remaining incision; if staples are used they will be removed once the wound is properly healed.