FORAMINOTOMY

What is a Foraminotomy?

The clinical term “foraminotomy” refers to a spinal surgery that a neurosurgeon performs to enlarge the passage from where the spinal nerve bundles to the body from the spinal cord ¹. This surgical procedure relieves pressure from the compressed spinal nerve root. Depending on the location of the nerve compression, neurosurgeons can perform this operation at any level of the spinal column. Nerve compression usually occurs due to the deposition of bones, discs, scar tissues, or excess development of ligaments. This may result in a pinched nerve. Foraminotomy involves the removal of these compressors such as a small bony portion, scar tissues, soft tissues, etc. that causes the compression of nerve roots. Disc prolapse also removes in several cases by the microdiscectomy technique.

A series of bones called vertebrae make up a spinal column. The intervertebral discs between each vertebra  act as a cushion. This spinal column houses the spinal cord  and protects it from injury.  The spinal cord transports  sensory signals to the brain from the body and vice versa.  Nerves inside the spinal cord help to sending and receiving that information. These nerves exit from the spinal column through a small hole called the intervertebral foramen. Sometimes these openings will narrow down and compression of nerves occurs. Whenever this happens, a patient may feel several symptoms of nerve compression.

Obvious symptoms of nerve compression include muscle weakness, pain in the arm, back, or neck, unsteadiness, aching or stiffness in the arm, numbness, partial paralysis in the arm, tingling, changes in the bladder or bowel, etc. The exact symptoms depend upon the location of the nerve compression along the spinal column. For example, nerve compression in the neck may cause neck pain and tingle in the arm and neck muscles. While performing a foraminotomy, surgeons make a minor cut on the patient’s back and remove the blockage.

What’s the Conditions for a Foraminotomy?

Patients with nerve compression may need a foraminotomy to remove the compression by widening the spinal canal. Spinal stenosis may occur due to the blockage of the spinal column or intervertebral foramen. Basic conditions for foraminotomy may include ²:

• Degenerative arthritis of the spine (spondylosis) that causes the formation of bony spurs;
• Bulging of the intervertebral disc;
• Spondylolisthesis;
• Enlargement of the ligament in the spine;
• Disc degeneration or osteophytic disease;
• Development of a cyst or hematoma;
• Prolapse of the intervertebral disc;
• Spinal stenosis;
• Formation of a tumor;
• Congenital disorders such as dwarfism;
• Certain skeletal disease e. g. Paget’s disease;

What’s the different Types of a Foraminotomy?

According to the location of the operation, a neurosurgeon may classify a foraminotomy into 3 different types: cervical foraminotomy, thoracic foraminotomy, and lumbar foraminotomy ³. Cervical foraminotomy occurs when this operation performs due to the compression of nerve roots in the cervical regions. Similarly, thoracic and lumbar foraminotomy performs when this spinal disorder involves the compression of thoracic and lumbar spinal nerve roots, respectively.

What’s the risks associated with a Foraminotomy?

All surgical operations have some risk. A study reported the incidence rate of infection after foraminotomy ranges from 1% to 12% ⁴. Similar to other surgical operations, foraminotomy possesses the same risks. The most common postoperative complications of foraminotomy include-

• Infections in soft tissue and bone,
• Excessive hemorrhage,
• Damage of the spinal cord,
• Formation of a blood clot (hematoma)
• Damage of the spinal nerves
• Leakages of the cerebrospinal fluid (CSF)
• Stroke
• Shock due to the loss of excessive fluid
• Paralysis, etc.

Surgeons usually discuss all the operative and post-operative risks with the patients before the operation. The associated risk factors of patients for foraminotomy include old age, genetics, site of operation, antibiotic prophylaxis, cardio-pulmonary disease, use of steroid, and duration of the operation.

How should a patient prepare for a Foraminotomy procedure?

Patients need to consult with their neuorosurgeon about their qualifications for the foraminotomy surgery. Surgeons usually suggest a patient stop taking such medicines as blood thinners ahead of the time of operation. Patients also need to avoid food and drink after midnight the night before their foraminotomy. Just before the surgery, the spinal surgeon usually performs additional imaging tests such as magnetic resonance imaging (MRI) to get more information about the spinal column and nerves.

How does a Spinal Surgeon perform Foraminotomy?

Foraminotomy requires a well-trained neurosurgeon, an anesthesiologist, and an assistant to perform successfully. The overall process includes ⁵:

• Patients will lie on the stomach on the operation table.
• Anesthesiologists will administer general anesthesia so that the patient will not feel pain or sensation during the operation.
• Surgeon will make a slight incision in the middle of the back of the spine.
• The blockage will expose by pushing away the skin, muscles, and ligaments.
• Surgeons will remove the blockage such as bony spurs, tissues, etc. to open the nerve root.
• In some cases, surgeons may perform a laminectomy to remove the part of the vertebra or spinal fusion to make the spinal column stable after the operation.
• Finally, the neurosurgeon will put the muscles and tissues back and suture the skin together.

How long does a Foraminotomy procedure typically take?

Usually, a foraminotomy requires a couple of hours to complete successfully. During the operation, nurses usually observe the vital signs of the patients such as heart rate, respiration, etc. Surgeons need to carefully think about the complications of foraminotomy while performing the operation. A study reported the complication rate of foraminotomy ranges from 2% to 9%.

What’s expected from a Foraminotomy recovery?

After foraminotomy, nurses need to carefully monitor each patient’s vital signs for a minimum of 24 hours. This procedure requires follow-up monitoring for a few weeks, even after surgery. Patients usually stay at the hospital based on the extent of the surgery. The maximum patient requires at least one or two days of hospital care. Nurses will try to avoid those post-operative complications during patients’ stay at the hospital. This requires regular monitoring with the correct administration of medications such as antibiotics, painkillers, etc. for a certain period of time. Some patients may develop some post-surgical symptoms of the operation, which diminish day after day. The patient requires up to 8 weeks for a full recovery. During any emergency, an immediate appointment will the doctor may help the patient.

If you want more information on a Foraminotomy procedure from a Fort Worth Brain and Spine Surgeon, we will happily assess and diagnose your unique situation.  Please call or CONTACT one of our Specialists’ today.

References

Chung, S. W. et al. Posterior cervical foraminotomy for cervical radiculopathy: should cervical alignment be considered? J. Spine Surg. 5, 541–548 (2019).

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