What is a foraminotomy?

A foraminotomy is a surgical procedure that enlarges the area around one of your vertebrae. The operation relieves pressure on compressed nerves.

Your backbone (spinal column) consists of a chain of bones, the vertebrae. The intervertebral discs sit above and below the flat portion of each vertebra to provide support.

Your spinal column houses your spinal cord and helps protect it from injury. The spinal cord sends sensory information from the body to the brain. The spinal cord also sends commands from the brain to the body. Nerves radiate from the spinal cord, sending and receiving this information. They exit the spinal column through the intervertebral foramen, a small hole that lies between the vertebrae.

For various reasons, sometimes these openings can become too small. When that happens, the compressed nerve can cause symptoms like pain, tingling of the extremities, and weakness. The exact nature of the symptoms depends on the location of the compressed nerve along the spinal column. (For example, a compressed nerve in the neck may lead to neck pain and tingling and weakness in the hand and arm.)

During your foraminotomy, your surgeon will make an incision on your back or neck and expose the relevant vertebra. Then he or she can surgically widen your intervertebral foramen, removing whatever obstructions are present.

Why might I need a foraminotomy?

Obstructions that narrow the spinal column or block an intervertebral foramen are called spinal stenosis. Various processes can obstruct the intervertebral foramen and compress the nerve leaving the spinal cord. Conditions that can cause spinal stenosis include:

  • Degenerative arthritis of the spine (spondylosis), which can cause bony spurs
  • Degeneration of the intervertebral discs, which can cause them to bulge into the foramen
  • Enlargement of the nearby ligament
  • Spondylolisthesis
  • Cysts or tumors
  • Skeletal disease (like Paget disease)
  • Congenital problems (like dwarfism)

Degenerative arthritis of the spine (from old age) is one of the most common causes.

This nerve compression can happen along any point of your spinal column. Your compressed nerve may start to cause symptoms, like pain in the affected region and tingling and weakness in the affected limb. You might need a foraminotomy if you’ve already tried other treatments and had no success, like physical therapy, pain medications, and epidural injections.

Usually, your doctor can perform foraminotomy as an elective procedure to help relieve these symptoms. You might need to have an emergency foraminotomy if your symptoms are quickly getting worse or if you have problems with your bladder due to your nerve.

What are the risks of a foraminotomy?

Foraminotomy is successful in most people, but complications can occasionally happen. Most of these are rare. Some possible complications include:

  • Infection
  • Excess blood loss
  • Nerve damage
  • Damage to the spinal cord
  • Stroke
  • Complications from anesthesia

There is also a small risk that the procedure will not relieve your pain. Your own risk of complications may vary according to your age, the location and anatomy of your intervertebral foramen, the type of foraminotomy performed, and your other medical conditions. Ask your doctor about the risks that most apply to you.

How do I get ready for a foraminotomy?

Talk to your doctor about how to prepare for your surgery. Ask whether you should stop taking any medications ahead of time, like blood thinners. You’ll need to avoid food and drink after midnight the night before your procedure.

Before your surgery, your doctor may order additional imaging tests to get more information about your spinal column and nerves. The most common test in this setting is magnetic resonance imaging (MRI).

What happens during a foraminotomy?

Your doctor can help explain the details of your particular surgery. (The following outlines a minimally invasive type of foraminotomy. Incisions are wider in a traditional foraminotomy.) A neurosurgeon and a team of specialized nurses and health care professionals will perform the surgery. The whole operation will take a couple of hours. In general, you can expect the following:

  • During the procedure, you’ll lie on your stomach.
  • Someone will give you anesthesia, so that you’ll sleep through the operation and won’t feel any pain or discomfort during the procedure.
  • Someone will carefully monitor your vital signs, like your heart rate and blood pressure, during the operation.
  • Your surgeon will make a small incision just beside your spine on the side you have your symptoms. He or she will make the incision at the level of your affected vertebra.
  • Your surgeon will use X-rays and a special microscope to guide the operation.
  • Using special instruments, your surgeon will push away the back muscles surrounding the spine to expose the blocked intervertebral foramen.
  • Your surgeon will use small instruments to remove the obstruction inside the intervertebral foramen, like the spur of a bone or a bulging disc. This will relieve pressure on the nerves.
  • In some cases, your surgeon might perform another procedure at this time, like a laminectomy (which removes part of the vertebra).
  • The team will remove the instruments and put your back muscles back in place. Someone will then surgically close the small incision in your skin.

What happens after a foraminotomy?

Talk to your doctor about what to expect after your foraminotomy. Within a couple of hours, you should be able to sit up in bed. You might have a little pain, but you can have pain medications to ease the pain. You should be able to eat a normal diet.

You’ll need to move the operated area carefully. Someone will tell you if you need to avoid any specific movements for the time being. (For example, you might need to avoid bending your neck if your foraminotomy was in this region.) You’ll also probably need a soft neck collar if your surgery was in your neck.

You should be able to go home a day or two after your surgery. Be sure to follow all of your doctor’s instructions about medications, physical activity, and wound care. You may need to avoid certain movements for a while. You may be able to do light work in a few weeks, but you may need to avoid heavier work for a few months. Some people might need physical therapy as they recover.

Your doctor can give you a realistic idea of what to expect after your surgery. Remember to keep all follow-up appointments. Most people will note a marked improvement in their symptoms. Be sure to tell your doctor if you don’t improve, or if you note new or worsening symptoms.

Next steps

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure
  • The reason you are having the test or procedure
  • The risks and benefits of the test or procedure
  • When and where you are to have the test or procedure and who will do it
  • When and how will you get the results
  • How much will you have to pay for the test or procedure