Foraminotomy: what is it, what is it for and what to expect from this surgery?

It is essential that spine surgeries are performed by experienced professionals and in clinics that have advanced technology, in order to obtain the best results and ensure patient safety. In this post, we will focus on foraminotomy, a surgical technique used to treat nerve compression problems in the spine. We will explore what it is, what it is used for, and what to expect from this surgery.

What is foraminotomy?

Foraminotomy is a surgical technique used in the spine to relieve nerve compression. This compression can be caused by different factors, such as a herniated disc, a bone spur, or spinal canal stenosis.

This surgical technique involves removing tissue that is compressing a nerve or spinal cord in the spine. The patients who may require a foraminotomy are those who experience pain, numbness, weakness, or loss of sensation in the neck, back, arms, or legs due to nerve compression.

The origin of foraminotomy dates back to the 1940s, when spine surgeons began exploring surgical techniques to treat nerve compression in the spine. Since then, the technique has been refined and updated to achieve more precise and effective results in relieving pain and other symptoms of nerve compression in the spine.

Different types of foraminotomy

Importantly, there are different types of foraminotomy, and each is designed to address a specific type of nerve compression in the spine. That's why he type of foraminotomy to be performed will depend on the diagnosis and the particular situation of each patient.

Below we present some of the most common types of foraminotomy:

• Cervical foraminotomy: It is performed at the top of the spine, in the neck area.
• Lumbar foraminotomy: It takes place in the lower area of the spine, in the lumbar region.
• Endoscopic foraminotomy: This is a minimally invasive technique that uses an endoscope to access the spine and perform surgery. Additionally, it offers faster recovery.
• Laser foraminotomy: A laser is used to remove tissue that is compressing the nerve in the spine. This type of foraminotomy is also less invasive than traditional techniques.
• Open foraminotomy: It is the traditional surgical technique and is performed through an incision in the skin to access the spine. This type is more invasive, but is sometimes necessary to address certain more severe cases of compression.

In which cases is it necessary to perform a foraminotomy?

In general, foraminotomy is caused by different degenerative disorders. Performing a foraminotomy will depend on the individual evaluation of each patient and their specific clinical situation, so it is always necessary to consult a specialist to determine the best treatment option.

Some most common causes of nerve compression that may require a foraminotomy include:

• Herniated disc: when the internal material of the vertebral disc moves out of place and puts pressure on the spinal nerves.
• Spinal stenosis: a narrowing of the spinal canal that can compress the spinal nerves.
• Spondylolisthesis: a condition in which a vertebra moves out of its normal position and puts pressure on the spinal nerves.
• Osteoarthritis: a degenerative joint condition that can cause bone spurs to form that compress spinal nerves.
• Spinal column tumors: They can compress spinal nerves and require a foraminotomy to relieve pressure.
• Infections or inflammations of the spine: They can also put pressure on spinal nerves and require surgery to treat nerve compression.

How is a foraminotomy performed? Step by step surgery

Foraminotomy is a spinal surgery that It is performed under general anesthesia and requires an incision in the patient's back. The duration of surgery may vary depending on the complexity of the case, but generally lasts between one and two hourss.

The steps carried out during surgery are as follows:

• Patient positioning: The patient is placed face down on the operating table, so that the surgeon has access to the spine.
• Identification of the site of nerve compression: With the help of images, the surgeon identifies the exact site of nerve compression.
• Making the incision: An incision is made in the patient's back above the affected vertebral level, and the muscles are separated to gain access to the spinal column.
• Removal of bone tissue: The surgeon removes the bone tissue that is compressing the spinal nerve.
• Foramen enlargement: Once the bone tissue has been removed, the space of the vertebral foramen is expanded, which is the natural opening through which the spinal nerves exit.
• Nerve release: Once the foramen space has been expanded, the spinal nerve is released from compression, relieving symptoms of nerve compression.
• Incision closure: After the surgery has been completed, the incision in the patient's back is stitched.

How do I prepare for a foraminotomy?

Preparation for a foraminotomy is important to ensure a safe surgery and adequate recovery. It is important to follow the specific surgeon instructions for preoperative preparation, which generally include:

• Inform the surgeon about any medications that is being taken, including over-the-counter medications and dietary supplements, as some may interfere with surgery and may need to be stopped temporarily.
• Perform necessary medical examinations, such as blood tests and x-rays, to evaluate the patient's general health and make sure they are fit to undergo surgery.
• Fast before surgery, following the surgeon's specific instructions about when to stop eating and drinking before surgery.
• Prepare a postoperative recovery plan, which includes help from friends or family with mobility and self-care during the first weeks after surgery.

It must be taken into account that nervousness or anxiety may be normal before surgery, so it is always important to talk to your surgeon about any concerns and ask questions to ensure you are well informed and prepared.

What risks and complications does foraminotomy have?

Although Foraminotomy is a common and safe surgical procedureLike any surgery, there are associated risks and complications that must be considered before undergoing the intervention.

The main risks and complications of a foraminotomy may include:

• Excessive bleeding: It may require blood transfusions or even a second surgery to control bleeding.
• Infection: It may require antibiotic treatment or even additional surgery to clean the infected area.
• Nerve or spinal cord injury: There is a risk of injury to the nerves or spinal cord, which can result in chronic pain, weakness or paralysis.
• Chronic pain: It may require treatment with pain medications or even a second surgery.
• Mobility problems: Some patients may experience mobility problems due to scarring or damage to tissues near the operated area.

What results should I expect after a foraminotomy?

In general, the main goal of a foraminotomy is to relieve pain and other symptoms associated with nerve compression in the spine. However, The results of a foraminotomy vary depending on the cause of the surgery, the extent of pressure on the nerves before the procedure, the severity of the underlying condition, the skill of the surgeon and the general health of the patient.

After surgery, many patients experience a immediate decrease in pain and the discomfort they had before surgery; while others may notice a gradual improvement in symptoms as the operated area recovers.

It is important to consider that recovering from spine surgery can be a long process and may require physical therapy and other complementary treatments to obtain maximum benefit.

Alternatives to a foraminotomy

There are several Alternatives to a foraminotomy, both surgical and non-surgical.

Among the surgical alternatives are laminectomy, which consists of the removal of the vertebral lamina to decompress the spine, and the discectomy, which is the removal of a part of the intervertebral disc that is pressing on the nerves. These surgeries can also be performed using minimally invasive techniques, depending on the condition and the particular case of each patient.

Non-surgical alternatives include pain management with medicines, the physiotherapy, the acupuncture and other complementary treatments such as chiropractic, massages, and the occupational therapy. Additionally, lifestyle changes such as weight loss, a healthy diet, regular exercise, and stress reduction can also help improve symptoms of spinal conditions.

Foraminotomy is an effective surgical technique in the hands of experienced professionals in clinics with advanced technology. In ICAC We have a multidisciplinary team of spine specialists that focuses on providing the best possible care to our patients. If you have questions or would like to schedule a consultation, please feel free to request a private appointment in it Institute of Advanced Spine Surgery.