Foraminotomy: Purpose, Procedure, And Recovery

The lower region of the brain is continuous with the spinal cord. The spinal nerves emerge from the spinal cord and travel throughout the internal organs, arms, and legs to control movement and detect sensation. The spine, or backbone, runs from the base of the skull to the tailbone and protects the spinal cord from injury.

The spine contains many spaces, or foramen, that allow the spinal nerves to pass and travel to and from muscles and sensory nerve endings. A foraminotomy is a surgical procedure to widen those openings if they become narrow, relieving pressure on nerve roots in the spine.

There are two types of spinal foramen:

• Vertebral foramen: The entire spinal cord runs through the center of the vertebral foramen.
• Intervertebral foramen: The spaces through which the spinal nerves enter and exit the spine.

A foraminotomy aims to widen either type of foramen.

A foraminotomy can treat several conditions, including:

• Spinal foraminal stenosis: This refers to a narrowing of parts of the spine, leading to nerve compression, which can cause pain, numbness, and weakness.
• Cervical radiculopathy: Also known as a pinched nerve in the neck, this condition occurs when a nerve root in the cervical spine compresses.
• Degenerative conditions: This is when the function and structure of the spine degenerate or weaken over time. This can arise due to stenosis, a slipped disk, or osteoarthritis.
• Failed back surgery syndrome: This is when someone experiences spinal pain with an unknown cause. The pain must either persist despite surgery, have developed after surgery, or have worsened after surgery.

Doctors can also use foraminotomy to treat back pain in older adults.

There are several ways to perform a foraminotomy. A transforaminal endoscopic lumbar foraminotomy (TELF) may involve the following steps:

1. Preparing the patient: An anesthetist gives general anesthesia so the person sleeps throughout the procedure. The individual lies face down on an operating table with their head on a soft pillow.
2. First steps: A fluoroscopy is an imaging technique that works with X-rays. Surgeons use it to determine where to make the first incision around the spine. After making this incision, they use a vice-like instrument to prise apart the flesh around the spine, allowing them to operate on the bone.
3. Foraminotomy: The doctors use a high-speed drill to remove some bone around the spine. This will widen the spine’s nerve openings. Doctors might also use special nerve hooks to move some nerves into a better position.
4. Final steps: Doctors will remove loose fragments of bone, remove surgical instruments, and sew the skin back together.

A person can help prepare for surgery and recovery by:

A foraminotomy takes place under anesthesia, which usually requires a person to fast for 6 to 12 hours before the operation. The surgeon will give instructions about when to stop eating and drinking before the procedure. They may also advise stopping or adjusting certain medications.

A person needs to arrange transportation and assistance to get to and from the hospital. Help from family, friends, or professional home carers will also be necessary following surgery.

Recovery from a foraminotomy varies, and it may depend on the extent of surgery and a person’s physical fitness. Most people can sit up and get out of bed within 2 hours of surgery. Some can go home the same day, though others may need a few days to recover in the hospital.

At the hospital, healthcare professionals will encourage the person to walk around their room or along the corridor, gradually building up their physical activity.

Once home, an individual may need help to care for their wound.

Doctors may recommend not driving for at least 2 weeks. They may also advise on avoiding the following activities for at least 6 weeks:

• lifting heavy objects
• bending
• twisting or turning the neck or spine

Doctors may recommend specific medications to help with any post-operative pain, which may last several weeks.

Physical therapy may be necessary to encourage optimal mobility after surgery.

Pain is common during the recovery period, but persistent pain lasting longer than a few weeks is a complication. There is also a small risk of injury to the part of the nerve root that connects to the spinal cord. Such nerve injuries can cause localized muscle weakness and skin numbness. Other rare complications of a foraminotomy include:

• wound infection
• blood pooling near the operated-upon area
• spinal fluid leak

Very rare complications of a foraminotomy include:

• slipped bones, requiring more surgery
• spinal cord injury, which could result in paralysis
• injury to blood vessels supplying the brain, which could cause a stroke or death

Other possible complications include blood clots, chest infections, and bleeding. Anyone eligible for a foraminotomy can discuss the possible complications with their doctor.

Foraminotomy can provide full or partial relief from the pain due to conditions such as stenosis and slipped disks.

The authors of a 2021 review estimated that around 85% of people experienced significant pain reduction after receiving a TELF.

Older evidence from 2016 suggests that open surgery and minimally invasive versions of foraminotomy are roughly equally effective. In both cases, the success rate was above 90% when treating herniated disks or stenosis.

Foraminotomies aim to reduce pain in conditions such as stenosis.

Spinal nerves travel through spinal foramen, which are spaces in the spine. Several conditions can cause those openings to narrow, putting pressure on the nerves. A foraminotomy is when doctors surgically widen the openings.

A foraminotomy takes place under anesthetic, as it involves cutting the skin and possibly drilling or cutting the spine. Pain is common for a few weeks after surgery. Most people can return home the same day, while some need to stay in the hospital for a few days.