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About Foraminotomy

The body's central nervous system consists of the brain and spinal cord, and the nerves connecting the spinal cord to the body or peripheral nervous system. The spinal cord travels down the spinal canal formed by the bony vertebral body, cushioning discs and two laminae. The laminae also provide the spinous process for the attachment of the muscles and ligaments of the neck and back.

The spinal nerve roots that carry motor, sensory, and autonomic signals from the brain exit though the intervertebral foramen formed between the disc and laminae. These spinal roots then branch out through the body. The nerve branches are categorized into four main groups that exit the vertebral column as the spinal cord moves down the back: the neck's cervical, the mid-back's thoracic and the lower back's lumbar and sacral nerves. The lumbar neural roots are associated with the motor and sensory nerves serving the legs.

Disc deterioration or movement can compress the size of the foramen neural passage. Additionally, bone spurs from the laminae may extend into the foramen to narrow the opening. Constriction of these foramen passages can exert pressure on the nerves resulting in pain, numbness, tingling sensations and weakness in the limbs. When other treatments fail to relieve these symptoms, lumbar foraminotomy is recommended.

Open lumbar foraminotomy requires the muscles to be cut to allow complete access to the laminae and disc. Alternatively, minimally invasive laser spine surgery may be employed that does not require opening of the spinal canal but requires only a small incision and simple muscle displacement for introduction of a tube through a small hole for access to the vertebrae.

A surgical microscope, an endoscope, is inserted to guide the removal of disc fragments, overgrown ligaments and bone spurs to enlarge the foramen and relieve nerve impingement. In either procedure, the muscles and soft tissue are then returned to their proper positions and the opening is sutured.

Recovery

Laser spine surgery can be done on an outpatient basis. However, open surgery patients may require a day or two to recover in the hospital. Many patients previously suffering from severe pain will often feel a significant improvement soon after surgery. Sensations of numbness, tingling and weakness in the legs usually improve more gradually. With open surgery, incision site pain and back spasms may occur that require medication. Laser spine surgery avoids many of these issues due to a small incision, resulting in a quicker recovery time. Lifting, bending or twisting should be avoided initially, but many patients are able to resume work in two to six weeks.

Surgical Risks

Like most surgery, foraminotomy presents a slight risk of postoperative bleeding and infection. Injury to the nerve or spinal cord is extremely rare. However, any potential for serious risks should be carefully discussed with the surgeon.

  

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