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Foraminotomy

Definition

Foraminotomy is surgery that widens the opening in your back where nerve roots leave your spinal canal. You may have a narrowing of the nerve opening (foraminal stenosis).

Alternative Names

Intervertebral foramina; Spine surgery - foraminotomy

Description

Foraminotomy takes pressure off of a nerve in your spinal column. This allows the spine to move more easily. Foraminotomy can be performed on any level of the spine.

You will be asleep and feel no pain (general anesthesia).

During surgery:

  • You lie face down on the operating table. A cut (incision) is made in the middle of the back of your spine. The length of the incision depends on how much of your spinal column will be operated on.
  • Skin, muscles, and ligaments are moved to the side. Your surgeon may use a surgical microscope to see inside your back.
  • Some bone is cut or shaved away to open the nerve root opening (foramen). Any disk fragments are removed.
  • Other bone may also be removed at the back of the vertebrae to make more room (laminotomy or laminectomy).
  • The surgeon may do a spinal fusion to make sure your spinal column is stable after surgery.
  • The muscles and other tissues are put back in place. The skin is sewn together.

Why the Procedure Is Performed

A bundle of nerves (nerve root) leaves your spinal cord through openings in your spinal column. These openings are called the neural foramena. When the openings for the nerve root become narrow, it can put pressure on your nerve. This condition is called foraminal spinal stenosis.

This surgery may be considered if you have severe symptoms that interfere with your daily life. Symptoms include:

  • Pain that may be felt in your thigh, calf, lower back, shoulder, arms or hands. The pain is often deep and steady
  • Pain when doing certain activities or moving your body a certain way
  • Numbness, tingling, and muscle weakness

You will have an MRI to make sure foraminal stenosis is causing your symptoms.

You and your doctor can decide when you need to have surgery. Foraminal stenosis symptoms often become worse over time, but this may happen slowly.

Risks

Risks of any anesthesia are:

Risks of forminotomy are:

  • Bleeding
  • Infection in wound or vertebral bones
  • Damage to a spinal nerve, causing weakness, pain, or loss of feeling
  • Partial or no relief of pain after surgery
  • Return of back pain in the future
  • Thrombophlebitis

Before the Procedure

Tell your doctor or nurse what medicines you are taking. This includes medicines, supplements, or herbs you bought without a prescription.

During the days before the surgery:

  • Prepare your home for when you leave the hospital after surgery.
  • If you are a smoker, you need to stop. Your recovery will be slower and possibly not as good if you continue to smoke. Ask your doctor for help.
  • Two weeks before surgery, your doctor or nurse may ask you to stop taking medicines that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn).
  • If you have diabetes, heart disease, or other medical problems, your surgeon will ask you to see your regular doctor.
  • Talk with your doctor if you have been drinking a lot of alcohol.
  • Ask your doctor which medicines you should still take on the day of the surgery.
  • Let your doctor know right away if you get a cold, flu, fever, herpes breakout, or other illnesses.
  • You may want to visit a physical therapist to learn exercises to do before surgery and to practice using crutches.

On the day of the surgery:

  • You will likely be asked not to drink or eat anything for 6 to 12 hours before the procedure.
  • Take the medicines your doctor told you to take with a small sip of water.
  • Bring your cane, walker, or wheelchair if you have one already. Also bring shoes with flat, nonskid soles.
  • Your doctor or nurse will tell you when to arrive at the hospital. Be sure to arrive on time.

After the Procedure

You will likely wear a soft neck collar afterward if the surgery was on your neck. Most people are able to get out of bed and sit up within 2 hours after surgery. You will need to move your neck carefully.

You should be able to leave the hospital the day after the surgery. You should be able to drive within a week or two and resume light work after 4 weeks.

Outlook (Prognosis)

Foraminotomy for spinal foraminal stenosis will often provide full or some relief of symptoms.

Future spine problems are possible for all patients after spine surgery. If you had foraminotomy and spinal fusion, the spinal column above and below the fusion could have problems in the future. If you needed more than one kind of precedure in addition to foraminotomy (such as laminotomy, laminectomy, or spinal fusion), you may have more of a chance of future problems.

References

Curlee PM. Other disorders of the spine. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, PA: Elsevier Mosby; 2007:chap 41.

Park AL. Lower back pain and disorders: intervertebral discs. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, PA: Elsevier Mosby; 2007:chap 39.

Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial. Spine. 2010;35(14):1329-38.


Review Date: 11/15/2012
Reviewed By: C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.
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