Foraminotomy

What is a Foraminotomy?

The term “foraminotomy” refers to a surgical operation that enlarges the opening of the bone from where the spinal nerveleaves the spinal canal. This operation relieves pressure from the compressed nerve in the intervertebral foramen. We can perform foraminotomy at any level of the spine.

Foraminotomy involves the removal of a small amount of bone, joint, or soft tissues that cause compression of the nerve roots. Disc prolapse may also remove in some cases (microdiscectomy) ¹.

What are the most common conditions, symptoms, and ailments that a Foraminotomy Surgery treats?

A foraminotomy widens the opening of the spinal bone and performed for several reasons. Basic indications of foraminotomy include ²:

• Formation of bony spur due to degenerative arthritis;
• Bulging of the intervertebral discs due to degeneration;
• Enlargement of the ligament in the spine;
• Foraminal stenosis;
• Intervertebral disc prolapse;
• Spondylolisthesis;
• Formation of a tumor;
• Formation of cyst or hematoma;
• Cervical disc or osteophyte disease;
• Certain musculoskeletal disease e.g. Paget’s disease;
• Congenital anomalies e.g. dwarfism;

The associated risk factors for foraminotomy involve ³:

• Age and hereditary factor;
• Surgical site;
• Antibiotic prophylaxis;
• Cardio-pulmonary disease;
• Steroid use;
• Duration of operation;

Symptoms may depend upon the location of the compressed nerve along the spinal column. These include:

• Pain in the arm, back, neck, etc.
• Weakness in the muscle
• Unsteadiness
• Aching or stiffness in the arm
• Numbness or tingling in the arm
• Partial paralysis
• Bowel or bladder changes

During any surgery, complications may occur. The incidence of infection rate after foraminotomy operation ranges from 0.7 to 11.9% ⁴. Most common postoperative complications include:

• Infections in soft tissue and bone;
• Excessive hemorrhage;
• Formation of hematoma (blood clot);
• Spinal cord damage;
• Spinal nerve damage;
• Cerebrospinal fluid (CSF) leak;
• Shock;
• Stroke;
• Paralysis (if spinal cord injured);

How do neurosurgeons perform a Foraminotomy procedure?

This operation requires a neurosurgeon, an anesthesiologist, and a surgical assistant to perform foraminotomy successfully. Surgeons will require about two hours to complete the whole surgery. The process includes:

• Lying on your belly or sit up on the operation table.
• Anesthesiologists will give anesthesia to fall asleep. You will not feel any pain or sensation during the operation.
• Doctors will monitor your vital signs such as heart rate, respiratory rate, etc.
• Surgeon will give a small incision in the middle of the back of your spine.
• Skin, muscles, and ligaments will push away to expose the blocked intervertebral foramen.
• Your surgeon will remove the blockage or cut the bone to open the nerve root opening.
• If needed, your surgeon may remove some part of the vertebrae (laminectomy).
• Surgeon may do a spinal fusion to make the spinal column stable after the operation.
• Finally, your surgeon will put the muscles and tissues back in their place and suture the skin together.

Afterward, each patient’s vital signs carefully monitored for 24 hours. A follow-up monitoring for a few weeks requires for every patient after surgery. Post-surgical complications may arise if the post-operative not perfectly maintained. The nurse needs to monitor the patient regularly to avoid any complications during his stay in the hospital. The complication rate may range from 2% to 9% after this operation ⁵. The patient will take up to 8 weeks for a full recovery. In case of any emergency, an immediate appointment may require with the doctor.

References

1. Kwon YJ. Long-term clinical and radiologic outcomes of minimally invasive posterior cervical foraminotomy. Journal of Korean Neurosurgical Society. 2014;56(3):224–229. doi:10.3340/jkns.2014.56.3.224
2. Jagannathan J, Sherman JH, Szabo T, Shaffrey CI, Jane JA. The posterior cervical foraminotomy in the treatment of cervical disc/osteophyte disease: A single-surgeon experience with a minimum of 5 years’ clinical and radiographic follow-up – Clinical article. Journal of Neurosurgery: Spine. 2009;10(4):347–356. doi:10.3171/2008.12.SPINE08576
3. Terai H, Suzuki A, Toyoda H, Yasuda H, Kaneda K, Katsutani H, Nakamura H. Tandem keyhole foraminotomy in the treatment of cervical radiculopathy: Retrospective review of 35 cases. Journal of Orthopaedic Surgery and Research. 2014;9(1):1–6. doi:10.1186/1749-799X-9-38
4. Clarke MJ, Ecker RD, Krauss WE, McClelland RL, Dekutoski MB. Same-segment and adjacent-segment disease following posterior cervical foraminotomy. Journal of Neurosurgery: Spine. 2007;6(1):5–9. doi:10.3171/spi.2007.6.1.2
5. Heo J, Chang JC, Park HK. Long-term outcome of posterior cervical inclinatory foraminotomy. Journal of Korean Neurosurgical Society. 2016;59(4):374–378. doi:10.3340/jkns.2016.59.4.374