Foraminotomy Techniques – Bilateral, Posterior, and Anterior
With the different ways that a surgery can be performed it can be a little overwhelming trying to understand what will happen when you are on the operating table. Whether it is a bilateral foraminotomy, a posterior foraminotomy, or an anterior foraminotomy the goal of the surgery will be the same; enlarge the foramen to relieve nerve compression. The main difference in these foraminotomy techniques is the direction the surgeon approaches the foramen.
Bilateral Foraminotomy
In bilateral surgery the affected area is approached from both sides. A bilateral foraminotomy would be performed to gain access to either side of the foramen. This is beneficial if there is debris compressing the nerves that would not be substantially removed by a singular approach.
Anterior Foraminotomy
As stated previously the direction that a surgeon approaches the affected area of the spine is very important. With this being said most importantly, an accurate diagnosis of the patient’s condition must be made. Inaccuracy could and often will result in a poor decision for the approach. This will lead to a higher chance of surgical failure.
In an anterior foraminotomy the surgeon will gain access to the spine from the front rather than the back. In this case the surgeon would then be able to access a degenerative or otherwise damaged disc without needing to touch the nerve roots or remove bone that would likewise need to be removed if a posterior foraminotomy approach was taken.
Posterior Foraminotomy – Pre-Surgery
Most times during a posterior foraminotomy surgery the patient will be operated on under general anesthesia. During the operation the patient’s breathing will be assisted by a ventilator, meaning that a breathing tube will be placed in the patient’s throat. As a precaution antibiotics are given to the patient intravenously prior to the surgery.
Posterior Foraminotomy – The Procedure
The patient will be laying down face first in the prone position on an operating table equipped with special padding and supports. To sterilize the area and its surroundings where the incision will be made it is cleansed with a special solution. Everything that will be within contact of the incision is sterilized, including the surgeon and his team.
A 2-4 inch incision is then made to gain access to the damaged area of the neck; muscles and tissues will then be divided allowing the surgeon to see and manipulate the nerve / foramen. Combined with specialized tools and either a microscope, arthroscope, or endoscope the surgeon will then remove the offending materials. After a final check to make sure that all the offending materials have been removed the surgeon will then put the muscles and tissues back into place using dissolving sutures. The wound is then closed with surgical glue, sutures, or staples; if staples are used they are removed once the wound is considered fully healed.
A posterior foraminotomy procedure will usually take about 2 hours from start to finish and the patient should feel fully recovered in 2 – 4 weeks.
After Bilateral foraminotomy, posterior foraminotomy, and anterior foraminotomy
Most patients will be released 1 or 2 days after their surgery and return within 8-10 days for a follow-up visit with the doctor. If there are sutures or staples to be removed they will usually be removed at this time, although this is at the doctors discretion. If the patient still requires medications for pain or infection the doctor will refill them. If the doctor is satisfied with the patients progress light physical therapy will at this point be prescribed.
