Foraminotomy is a surgical procedure that opens up the foramen that nerve roots travel through as they leave the spine and enter the body. It’s performed most commonly in patients with lateral disc herniations that protrude into the foramen, creating narrowing or stenosis and compressing the exiting nerve. A foraminotomy is usually part of a larger procedure that involves ligamentum resection, partial laminotomy/laminectomy, medial facetectomy, and discectomy.
Newer MISS techniques allow foraminotomy to be performed through smaller incisions as an outpatient procedure in some cases.
Who is a candidate for Foraminotomy?
The most common indication for foraminotomy is injury causing disc herniations or arthritis that produces thickened ligaments, disc protrusions, and enlarged facet joints that compress the nerves and spinal cord producing spinal stenosis. This is most common in the neck and lumbar spine where most spinal motion occurs and less common in the midback (thoracic spine) as the ribs limit motion. Most patients with spinal stenosis are treated non operatively; patients with neurologic injury or those who fail to improve despite non operative treatment are candidates surgical treatment. Patients with instability or underlying deformity (kyphosis, scoliosis, spondylolisthesis) may also require an additional stabilization procedure with fusion and instrumentation.
What is involved in Foraminotomy?
A foraminotomy is usually part of a larger procedure to decompress the spine through an anterior approach (ACDF) or posterior approach (partial laminotomy, medial facetectomy, and discectomy). The posterior approach involves retraction of paravertebral muscles to access the involved level. The ligamentum flavum is resected and a partial laminotomy and medial facetectomy performed with Kerrison rongeurs and high speed burr. The nerve root is identified, elevated, and any underlying disc resected decompressing the exiting nerve root.
Figure 1. Illustration demonstrating partial laminotomy, medial facetectomy, and foraminotomy.
What are the pros and cons of Foraminotomy?
All surgical procedures have inherent risks. These include but are not limited to infection, dural tear, nerve injury, instability, and chronic pain. Each patient is unique and only a comprehensive evaluation with a fellowship trained spine surgeon can give you the best appreciation of the risks and benefits for surgical treatment of your condition.
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