Foraminotomy Surgery | Indications | Technique
When the spinal foramen narrows due to disc space compression or facet arthropathy, foraminotomy is often indicated.
Aggressive foraminotomy, like other decompressive techniques, can cause destabilization of the spine, particularly in the presence of progressive scoliosis or spondylolisthesis, and worsen the severity of slip or rate of curve evolution.
As a result, extra attention must be made to minimize facetectomy to the medial one-third of the facet joint and, if possible, to preserve the pars interarticularis.
Decompression of the nerve root on the concavity of a curvature, which frequently involves severe foraminal constriction, is difficult and sometimes impossible.
What is Foraminotomy?
It is a type of decompressive surgical operation that enlarges the hole into which the spinal nerve root exits the spinal column, primarily to treat symptoms of spinal nerve compression such as burning, numbness, or pain.
The procedure is often performed as a minimally invasive procedure with a small incision is formed in the back and a small opening bored into the vertebra.
The foramen can be viewed and the impending bone or disk mass excised through this opening using an arthroscopic procedure.
Indications of Foraminotomy
The following are the most commonly indicated causes for this surgery:
• Patients with symptomatic lumbar foraminal stenosis despite long-term conservative treatment
• Radiculopathy with foraminal or extraforaminal stenosis
• moderate to severe foraminal stenosis with nerve root collapse
• Disc herniation caused by disc degeneration
• Bone Diseases Such as paget’s disease
• Arthritis of the spine with resulting bone spurs
• Malignant tumors of the spine
• Paraspinal ligamentous enlargement
Contraindications of Foraminotomy
Several issues interfere with the surgery and it can’t be performed in their presence including the following:
• Segmental kyphosis.
• Vertebral body Diseases.
• Segmental instability.
• Mid-central disc herniation.
• Spinal cord compression or myelomalacia.
• Cervical myelopathy symptoms.
• Presence of symptoms that are not concordant with findings on an imaging study.
How Foraminotomy Surgery is Done?
You will be lying on your belly and given a general anesthetic to become asleep throughout the surgery.
The following are the main steps of the surgery:
• Making the Incision
The surgeon will make a small incision on your back just at the side of your spine at the level of the diseased vertebra. The surgery will be guided by an imaging study.
• Dissecting the muscles
The paraspinal muscles will be dissected or retracted to make the affected foramen obvious. The doctor will use a retractor to dissect the muscles.
• Releasing the pressure
The doctor will use special surgical instruments (punches, forceps, and lasers) to remove surrounding compressive elements such as bone spurs or bulging intervertebral discs.
• Closing the wound
The surgeon will return the dissected or retracted muscles to their place, close the incision using stitches, and cover the incision with appropriate gauze.
Risks of Foraminotomy
The following are the possible postoperative complications of the surgery:
• Postoperative infections such as pneumonia and urinary infections.
• Persistent pain after the surgery.
• Thrombophlebitis is an inflammation of the superficial veins and presents as a palpable painful cord.
• Intraoperative root or nerve injury.
• Recurrent disc herniation in case of management of the disc herniation.
• Cerebrovascular accident that is a thrombosis in the brain arterial trees.
• Copious blood loss with hemodynamic instability.
• Other complications related to the anesthesia.
How Long Does Foraminotomy Last?
The surgery usually lasts 2-3 hours with minimally invasive type lasting less. Postoperatively, you will stay in the recovery room for an hour and the hospital wards for 2-3 days.
Cost of Foraminotomy
The cost of this surgery lies between 14,000$ and 20,000$ with those who have medical insurance will pay less because the companies will cover part of the price.
The duration of the patient’s hospital stay is determined by the surgery’s complexity.
On the same day after the procedure, some patients may be discharged from the hospital. The majority of patients will need to stay in the hospital for two or three days.
The presence of pain at the surgical site is typical and to be expected. This pain subsides with time and can be managed with pain medication taken orally.
Many patients report quick relief from one or more of their pre-surgery symptoms. Symptoms may fade with time for some patients.
Patients who have a positive attitude and moderate goals and follow the spinal surgeon’s advice fare successfully. Within a few weeks, the majority of patients can resume their normal activity.