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What is a Foraminotomy ?

A Foraminotomy is a back surgery procedure used to enlarge the opening through which a spinal nerve passes as it exits the spinal canal. These openings in between the vertebrae are called Neuroforamen. When this opening is reduced due to a spinal problem or injury, there is less room for the nerves to pass between the bones. This sometimes causes a pinched nerve and the usual painful symptoms.A foraminotomy may be performed to treat foraminal stenosis, bulging or herniated discs, pinched nerves, scar tissue formation, bone spurs (osteophytes), spinal arthritis, or sciatica.

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During a foraminotomy, the surgeon arthroscopically removes bone and tissue compressing the spinal nerve root. The endoscope is slowly removed to allow muscles and other soft tissues to move back into place. Occasionally, a stitch or two is needed to close the small incision.

Surgical Treatment

The conditions usually treated with a foraminotomy include:

Herniated Discs

Herniated discs are extremely common back injuries. They occur when the thick outer layer (annulus fibrosus) of an intervertebral spinal disc bulges or ruptures. Sometimes, the gel-like interior of the disc (nucleus pulposus) will actually break through the outer layer and leak out into the body. This is called a ruptured or extruded disc.

Degenerative Disc Disease

Degenerative disc disease (DDD) is a condition in which the intervertebral discs dehydrate and shrink. DDD causes loss of disc height and reduction of the intervertebral spaces between vertebrae. This condition is usually found in the neck (cervical) and lower back (lumbar) regions of the spine. DDD is also called spinal degeneration or simply disc disease.

Arthritis in the Spine

Arthritis in the spine is a normal part of aging for most people. This condition goes by many names, including Osteoarthritis, Spondylosis, Spinal Arthritis and Degenerative Joint Disease. Arthritis is thought to be a contributing factor in many different back pain syndromes. The arthritic process are also the primary cause of facet joint syndrome. However, most osteoarthritic processes are normal, virtually universal and not responsible to significant or lasting back pain.
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Foraminal Stenosis

Foraminal stenosis is a spinal condition which commonly affects one or more spinal nerve roots. The foramen are the openings between vertebrae which allow the nerve roots to exit from the spinal column. There are foramen between each vertebrae allowing the various nerves to branch off from the spinal cord and serve the regional neurological requirements of the body. Stenosis is a condition which describes a narrowing or closing of a typical anatomical space. Therefore, stenosis of the foramen is the condition in which one or more foramen narrow, possibly impinging on a nerve root. This condition is commonly referred to as a pinched nerve.

All of these conditions can create narrow neuroforamen, which can cause pain and other neurological back pain symptoms.

Foraminotomy Procedure

The surgeon can choose 2 methods of doing this procedure. It can be a full open surgery, under general anesthesia. This would include spinal incision, muscle dissection, and possible laminectomy, to remove additional bone. If the surgeon is trained in minimally invasive procedures, then the operation can be done with an endoscope. This will save the patient much recovery time, pain and damage to healthy tissue.

Recovery from Surgery

The minimally invasive form of the procedure will require the patient to remain hospitalized for a few hours, while the full open version requires a stay of a few days. Obviously, minimally invasive back surgery will have the patient up and around faster, making it a preferable choice.

The patient will have to take it easy for a few weeks and do only limited physical activity. Physical therapy is common to help the patient regain full range of motion.

Foraminotomy Risks

As with all surgical procedures, there is risk from both the procedure and the anesthetic. Infection, bleeding, spinal fluid leak or possible nerve damage are all complications associated with this procedure. Make sure you know and understand all the risks before making a decision to have surgery.

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