Bundles of nerves leave the spinal cord through openings in the spinal column called neural foramens. Sometimes through aging or injury these openings narrow, pinching the nerves and causing pain. This pinched condition is called foraminal spinal stenosis. A foraminotomy is a surgical procedure to widen the foramens and relieve pain and pressure.
Doctors generally recommend non-invasive procedures before resorting to surgery. Massage, acupuncture, physical therapy, hot and cold packs and anti-inflammatory medication are all methods that might relieve foraminal spinal stenosis. But if these fail to work and the patient has severe symptoms –such as deep, steady pain in the extremities, numbness and muscle weakness, or difficulty walking or holding onto things—a foraminotomy might help.
The patient will be under general anesthesia and positioned on the belly or sitting up on the operating table. The surgeon cuts an incision in the back, its length depending on the extent of the problem, and retracts muscles, skin and ligaments to the side. Special instruments like a lighted surgical microscope help the surgical team get a good look inside. The surgeon shaves some bone to access the foramen and removes any disc fragments. Sometimes other surgical procedures will be necessary, such as removing some bone at the back of the vertebrae or doing a spinal fusion. After everything is put back into place, the surgeon sews up the incision.
Patients are usually able to get out of bed a couple of hours after surgery. If the operation was on the cervical vertebrae in the neck, the patient might need to wear a soft neck collar.
Depending on the patient and the extent of the procedure, they may be able to leave the hospital the same day of surgery, or an overnight stay might be required. They should be able to drive within two weeks after surgery and return to work after about four weeks, as long as the job isn’t physically demanding.
Like all surgeries, foraminotomy has some risks. The surgery might fail to resolve the pain, or pain may return in the future. Other risks include spinal nerve damage and infections in the vertebral bones or wound.