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Foraminotomy Procedure at Our Los Angeles Center

The small openings between each vertebra where nerve roots exit the spinal canal are called foramen. A foraminotomy is a surgical procedure to expand the size of these open spaces along the vertebrae to provide more room for the nerves to pass. This procedure serves a similar purpose to a laminectomy. In fact, a laminectomy is often done as part of the same treatment because the lamina is one part of the vertebra that is often involved in narrowing the foramen and compressing the nerves.

Problems Treated with Foraminotomy

If stenosis (narrowing of the foramen) develops, this can place pressure on the nerve root, causing it to become irritated and inflamed. This narrowing may be caused by a number of factors including:

  • Bone overgrowth (bone spurs)
  • Disc degeneration, bulging or slippage
  • Thickening and stiffening of the ligaments
  • Scar tissue from trauma or prior surgery

 

Patients who have spinal compression may experience a number of symptoms including:

  • Lower back pain
  • Limited mobility due to pain, muscle spasms or muscle weakness
  • Tingling, numbness, aching or burning sensations in the buttocks and legs

 

These symptoms may be relieved temporarily by sitting because this flexes the vertebrae in such a way that the foramen are expanded and pressure is taken off the nerve roots. However, the health conditions associated with nerve compression in the spine often get worse over the years due to wear and tear or because they are associated with a degenerative disease. Some patients also experience difficulty controlling their bowels and bladder as the spinal compression gets progressively more severe.

Who Is a Candidate for Foraminotomy?

Some of the medical conditions that may be treated by this type of spinal decompression include:

  • Spinal stenosis
  • Bulging or herniated discs
  • Bone spurs
  • Osteoarthritis or rheumatoid arthritis
  • Sciatica

 

Patients who do not respond to non-invasive treatments such as rest, cortisone injections, anti-inflammatory medications and physical therapy may benefit from this procedure.

Procedure Overview

In a minimally invasive foraminotomy, the surgeon makes a small incision in the skin on the back in the area where the nerve compression is occurring. After inserting a needle into the spine and checking with an x-ray to ensure that the correct area has been located, the surgeon inserts a small tube into the muscles over the spine, spreading them apart to see the spine clearly. Progressively larger diameter tubes are inserted until the opening is wide enough to insert an endoscope (a small viewing camera with a light) to see the spinal structures clearly.

Other tiny instruments to provide suction and irrigation as well as a laser or other cutting tools are also introduced into surgical site through the endoscope. These tools are used to widen the spaces between the vertebrae by removing small amounts of bone, cartilage, ligaments or other tissues that are compressing the nerve as it passes through the foramen. The goal is to provide sufficient room so the nerve root won’t be pinched but to leave as much healthy spinal structure intact as possible.

With a minimally invasive foraminotomy done under local anesthesia and IV sedation, most patients are up and walking within one to two hours after their surgeries. Some patients may be able to return home the same day while others may need to stay one or more days in the hospital. Return to sedentary work may be fairly fast if the amount of tissue removed is small, but the full recovery time may be several months. This varies significantly depending on the specifics of each patient’s surgery.

Risks, Side Effects and Benefits

Postoperative discomfort and the need for some physical rehabilitation are common side effects of this procedure. Pain and limitation in mobility should improve over time as the back and abdominal muscles are strengthened and the surgical site heals.

Rare but serious complications such as nerve damage, bleeding, blood clots, infection and spinal instability are possible with a foraminotomy. In some cases, the degeneration of the spine has reached a point where removal of a disc (discectomy) and fusion of the affected area of the spine is required to restore function. These procedures may be carried out in conjunction with the foraminotomy. The more extensive the surgery, the greater the risk of serious complications or a poor outcome.

If the foraminotomy is successful, patients may experience immediate relief from the symptoms of nerve compression, or the symptoms may subside more gradually as nerve irritation and inflammation resolves. Ideally, relief is long lasting and significant. However, the condition may return at the surgical site or elsewhere in the spine due to aging or degenerative disease.

The endoscopic approach is of particular interest to patients who want to avoid excessive blood loss, a large incision, a long hospital stay and unnecessary trauma to surrounding tissues. Minimally invasive techniques are, in general, associated with faster overall recovery and less pain after surgery.

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