What is a Foraminotomy?
Within the spine you have 24 vertebrae and in between each vertebra there is a disc. Spinal discs are rubber-like pads that provide cushion between vertebrae. Stacked together, your vertebrae create a spinal column which houses and protects your spinal cord. The spinal cord has nerves extending out into the body on either side of each vertebrae through a small window, the intervertebral foramen, where signals are then relayed to and from the body. These windows can sometimes become too small and push on the nerves within that space creating severe discomfort. A foraminotomy is a surgical procedure that is used to enlarge that window in order to relieve pressure on compressed nerves.
When Does One Need a Foraminotomy?
Spinal stenosis is a term for when the intervertebral foramen becomes blocked or the space is narrowed. Conditions that lead to spinal stenosis include, but are not limited to, the following:
Degeneration of intervertebral discs leading to the bulging of the disc into the foramen
Degenerative arthritis, which can cause bony spurs to accumulate
Spondylolisthesis, which is when a vertebra slips forward onto the bone beneath it
Cysts or tumors
Of those listed, degeneration of the spine from aging is among the most common conditions that lead to a foraminotomy. Spinal nerve compression is not limited to any one region. Symptoms induced from nerve compression include tingling or numbness in the affected limb and pain in the area of compression. Once a diagnosis is reached between you and your surgeon, a foraminotomy will be the last resort. It is highly recommended that a patient attempt other routes of relief such as epidural injections, physical therapy, and/or pain medication before becoming a candidate for surgery.
What Happens During a Foraminotomy?
In most cases you can expect the following during your foraminotomy:
First, the OR nurses will place you on your stomach for the surgery and you will be given anesthesia to put you to sleep
The surgeon will make a small incision on the side of your spine where the nerves are being compressed
X-rays and a microscope will be guiding your surgeon to the affected region
The surgeon will then use special tools to push back the muscle above the spine to expose the intervertebral foramen
Next, the surgeon will use small tools to cut a small window into the foramen to relieve pressure and to remove a bone spur or herniated disc if that applies.
Finally, the surgeon will remove the tools and close the incision.
It is also common for a surgeon to perform a laminectomy at the same time as a foraminotomy.
What Does Recovery Look Like?
Typically, you should be able to sit up in bed a few hours following the surgery and be allowed to go home the same day. Recovery will vary by person and the region of the spine that was operated on will play a large role in what you are and are not advised to do for the following weeks. Your health care provider will be able to outline specific Do’s and Don'ts for your recovery. Most people will see a great improvement in symptoms in the weeks post surgery.
What is a Laminectomy?
The lamina is the arched portion of the spine that makes the “roof” of the spinal canal. For a better picture of where it is, when you reach to touch your spine what you are really feeling is the spinal process, a bony protrusion, coming off of each lamina. When neck or back pain begins to interfere with daily life, a laminectomy may be considered. This procedure involves the removal of the spinous process and the entire lamina of the affected vertebra.
When is a Laminectomy Needed?
The most common cause for a laminectomy procedure is due to a herniated disc. A disc can herniate due to natural wear and tear or from an injury. This bulging out of a disc can put pressure on the nerve roots within the spinal cord causing extreme discomfort, numbness or tingling and/or weakness in the affected limb. Similar to a foraminotomy, this procedure is considered only after other routes for relief have been explored. It is often recommended that a patient attempt epidural injections, physical therapy, pain medication, and changes in activity. Loss of bladder or bowel control due to nerve damage can be a significant indication that surgery needs to happen.
What Happens During a Laminectomy?
For this procedure you will be put under anesthesia and you will be placed onto your stomach. Then the following steps will occur:
The surgeon will make a cut above the affected vertebra, this cut could be longer if there is more than one vertebra that needs a laminectomy
Special tools will be used to pull the muscles back to expose the spinous process and lamina
The surgeon will then remove the vertebral lamina including the spinous process and may also remove the herniated portion of a disc or bone spurs if that applies
The tools separating the muscle will be removed and the incision will then be closed
This procedure can be done in conjunction with a foraminotomy or spinal fusion if you and your surgeon agree on those additional procedures.
What Does Recovery Look Like?
Several hours post operation, you will be able to get out of bed and walk around. Many patients return home the same day. Recovery will vary patient to patient and your surgeon may put restrictions on you driving, bending over, and other activities for a few weeks while you recover. Physical therapy is most commonly recommended in the following weeks to build back any strength lost due to nerve compression and to ensure the stability of your spine for the future.
What is the major difference between a Laminectomy and a Foraminotomy?
Before deciding which procedure you will benefit most from, your surgeon will take into consideration the location of the nerve compression. For instance, if the nerve is being compressed on the right side of the spinal canal, a foraminotomy would be the route taken. However, if there is compression on the right side as well as in the center of the spinal canal then your surgeon may opt to perform a laminectomy. This way, they have full access to clear out all of the spinal stenosis to alleviate symptoms.
If you have questions or feel you may benefit from one of these operations, call the experts at Austin Neurosurgeons. Dr. Peterson has been performing foraminotomies and laminectomies since 1994. He covered regional Level 1 Trauma Center for 22 years and was responsible for half of all cervical and thoracolumbar spinal trauma cases presenting at Brackenridge/University Medical Center in Austin, Texas.