Introduction

Foraminotomy is a surgical procedure for widening the area where the spinal nerve roots exit the spinal column. A "foramen" is the opening around the nerve root, and "otomy" refers to the medical procedure for enlarging the opening. In this procedure, doctors widen the passageway to relieve pressure where the spinal nerve is being squeezed in the foramen.

A foraminotomy is performed to alleviate the symptoms of foraminal stenosis. In foraminal stenosis, nerve roots are compressed inside the neural foramina. This compression is usually the result of degenerative (or wear and tear) changes in the spine.

Wear and tear from repeated stresses and strains on the neck can cause a spinal disc to begin to collapse. As the space between the vertebral bodies shrinks, the opening around the nerve root narrows. The nerve root is squeezed in the foramen when the facet joint lining the outer edge of the foramen becomes inflamed and enlarged as a result of the same degenerative changes.

The degenerative process can also cause bone spurs to develop, causing further irritation. In a foraminotomy, the surgeon removes the tissues around the edges of the foramen, essentially widening the opening in order to take pressure off the nerve root.

Surgical Procedure

Patients are given a general anesthesia to put them to sleep during most spine surgeries. For shorter procedures such as foraminotomy, patients are usually given a gas form of anesthesia through a mask. As you sleep, your breathing may be assisted with a ventilator.

This surgery is usually done with the patient lying face down on the operating table. The doctor makes an incision down the middle of the back of the neck. The skin and soft tissues are separated on the side where the spinal nerves are compressed. Some doctors use a surgical microscope during the procedure to magnify the area they'll be working on.

The doctor may use a small, rotary cutting tool (a burr) to shave the inside edge of the facet joint. This opens up the outer rim of the neural foramen. The burr is sometimes used to shave a small section of the bony ring on the back of the vertebra above and below the affected nerve root.

Small cutting instruments are used to carefully remove soft tissues within the neural foramen. The doctor takes out any small disc fragments that are present and scrapes off nearby bone spurs. In this way, tension and pressure are taken off the nerve root.

The muscles and soft tissues are put back in place, and the skin is stitched together. Patients are sometimes placed in a soft collar after surgery to keep the neck positioned comfortably.

As with all major surgical procedures, complications can occur. Some of the most common complications following foraminotomy include problems with anesthesia, thrombophlebitis, infection, nerve damage, and ongoing pain.

After Surgery

Patients are usually able to get out of bed within an hour or two after surgery. Your doctor may have you wear a soft neck collar. If not, you will be instructed to move your neck only carefully and comfortably.

Most patients leave the hospital the day after surgery and are able to drive within a week or two. People generally get back to light work by four weeks and can do heavier work and sports within two to three months. Since recovery rates depend on each patient’s individual condition, you should discuss this with your doctor.

Outpatient physical therapy is usually prescribed when patients have extra pain or show significant muscle weakness and deconditioning.

Rehabilitation

Rehabilitation after foraminotomy surgery is generally needed for only a short period of time. If you require outpatient physical therapy, you will probably need to attend therapy sessions for two to four weeks. You should expect full recovery to take up to two or three months.