What is Foraminotomy?
Simply put, foraminotomy is a surgery that is meant to alleviate the pressure on compressed nerves. The pressure comes from intervertebral foramina. The intervertebral foramina are passages that allow nerve bundles to pass through to the body from the spinal cord. If the foramen is compressed by scar tissue, excessive ligament development, bones, or discs, the nerves become pinched. Foraminotomy can be performed in a minimally invasive manner. During the procedure, there is an incision in the back, the muscle is “peeled away to reveal the bone”, and then a “small hole is cut into the vertebra”. With an arthroscope, through this hole, “the foramen can be visualized, and the impinging bone or disk material removed”. If a large amount of bone or other materials are removed, the surgery is typically called a foraminectomy.1 There are several disorders that could cause nerve compression, including spinal stenosis, degenerative disc disease, bone spurs (or osteophytes), spondylosis (or spinal osteoarthritis), and herniated or bulging discs. Foraminotomy is considered a spinal decompression surgery because it “creates more space around the nerve”.2 The surgery is performed under anesthesia, as the patient lies face down on the table. Sometimes other bones are removed to make room during the surgery, and that is called a laminotomy or laminectomy. Surgeons may also do a spinal fusion to stabilize the spine after the surgery. The compression of the nerves due to the openings narrowing is called foraminal spinal stenosis. Those who are recommended for surgery include patients who have severe pain (in the calf, thigh, lower back, arms, hands, or shoulder), those who experience pain when moving the body a particular way, and those who are suffering from muscle weakness, tingling, and numbness. With surgery, there are risks, such as medication reactions, breathing difficulties, clots, infection, bleeding, and spinal nerve damage. For some, there may be no relief after the surgery, or the back pain could return in the future.3
Pre-Op and Post-Op
Prior to the surgery, patients will have an MRI. Smokers need to quit, since smoking interferes with recovery. Patients will be asked to stop taking aspirin, naproxen, and ibuprofen for two weeks before surgery. It is also important to discuss alcohol use with the doctor and to inform them about medications and supplements that are being taken. Also, the doctor will need to know if the patient has an illness, cold, flu, or fever. It might be useful to seek physical therapy to learn pre-surgery exercises and how to use crutches post-surgery. Generally, patients cannot eat or drink 6-12 hours prior to surgery. Most patients can get out of bed within hours of surgery. If the surgery is performed on the neck, the patient will likely use a soft neck collar and will have to move their neck carefully. Driving can resume in a couple of weeks, and the patient can return to light work after about a month. Patients may still have future spine problems after the surgery, especially if a spinal fusion is performed. Patients may have back troubles above and below the fusion. Difficulties are more likely when multiple procedures are performed.4
Types of Foraminotomy
There are a few types of foraminotomies, including cervical foraminotomy and lumbar foraminotomy. A cervical foraminotomy is performed at the neck. It would be recommended if patients have a lot of weakness or pain that cannot even be controlled by narcotics. In addition, candidates for this type of surgery might have myelopathy or spinal cord compression. During the procedure, there is an incision, the spinal bone is removed, then the surgeon will remove any bone spurs, thickened ligament, or herniated discs, and finally the muscles and tissues are put back in place and the wound is closed.5 Posterior cervical foraminotomy is a term that refers to the surgery in the back of the neck.6 Lumbar foraminotomy increases the space around the neural foramina in the lumbar area (lower back). The surgical process is about the same as noted earlier. Pain reduction may be felt very soon after the surgery, but the weakness, numbness, and tingling of the legs might have more gradual improvement. It is common to have back spasms and pain from the incision.7 Sometimes these surgeries are called endoscopic foraminotomy. Afterwards, only a small bandage is needed for the incision area.8
Non-Surgical Treatment Options
Surgery is not the answer for everyone. Some people have no relief after the surgery. There are alternative treatment options to surgery including chiropractic, physical therapy, and massage. Lower back pain, for example, can respond to these non-surgical treatment options, as well as heat and anti-inflammatory medications.9 In chiropractic, some of the drug-free, non-invasive treatment options include adjustment, soft tissue and massage therapy, exercises and stretches, and physical modalities. A few types of physical modalities are interferential stimulation, muscle stimulation, deep heating, and therapeutic ultrasound. Some patients are not candidates for chiropractic care (such as those with fractured bones), but many can try this type of treatment before taking on the risks of surgery.10 Massage is a great way to relieve muscle tightness. Exercise and stretching is helpful for low back pain and other types of musculoskeletal issues. Patients may wish to try yoga or Pilates. There are some herbal remedies that could be useful such as capsaicin cream. Some people could benefit from biofeedback, progressive relaxation, or even meditation.11
Learn more about foraminal narrowing or foraminal stenosis.