Foraminotomy

What is a foraminotomy?

A foraminotomy is surgery to relieve pressure on the nerve roots in your spine. This procedure opens up the foramen, or the opening in your vertebra bone where your nerve roots exit your spinal canal (the tube that holds your spinal cord). The nerves that exit your spinal canal through the foramen make up your peripheral nervous system.

If your foramen is narrow, you’ll experience nerve pain and other symptoms that affect your movement. A foraminotomy can relieve this pressure to reduce your pain.

What are the types of foraminotomy?

You may hear your surgeon specify the location of your foraminotomy. These are the same procedures, they just happen at different places on your spine:

• Cervical foraminotomy: Top of your spine (neck).
• Thoracic foraminotomy: Upper or middle part of your spine.
• Lumbar foraminotomy: Lower part of your spine (lower back).
• Sacral foraminotomy: Pelvis or far lower spine.
• Coccygeal foraminotomy: Tailbone.

What does a foraminotomy treat or manage?

A foraminotomy treats spinal stenosis. This is the narrowing of space within your spinal canal. Specifically for foraminal stenosis, the neural foramen (the opening in your spinal column where nerve roots leave your spinal canal) is too small. When your nerve roots don’t have the space they need, it causes the following symptoms that can interfere with your daily routine:

• Pain.
• Difficulty moving, walking or holding objects.
• Numbness and tingling in your arms and legs.
• Muscle weakness.
• Incontinence.

Is a foraminotomy a major surgery?

Yes, a foraminotomy is a common major surgery. Your surgeon will need to access your spine and they’ll be working next to your spinal cord. There are minimally invasive options for cervical foraminotomy, but it’s still considered a major surgery based on the location. Spine surgeons who specialize in this procedure are highly trained to make this surgery as safe as possible, to reduce side effects and to help you feel better.

How should I prepare for a foraminotomy?

You’ll meet with a surgeon before a foraminotomy. They’ll perform an exam and review your medical history. They’ll also order imaging tests like an MRI or a CT scan to plan for the procedure.

Let your surgeon know what medications or supplements you currently take, especially if you take blood thinners. They may make changes to the dosage or add a new medication to prevent side effects of surgery. Don’t make changes to your medications unless your healthcare provider approves it.

You should also visit any specialists you see regularly to make sure you’re well enough to undergo surgery; for example, if you have heart disease or diabetes.

Your surgeon may suggest you stop or reduce the use of tobacco products and beverages containing alcohol, which can interfere with how your body heals after surgery.

Also, your surgeon will give you specific instructions to follow on the day of the surgery. This could include not eating or drinking anything for up to 12 hours before the procedure and when and where to go for the surgery.

What happens during a foraminotomy?

On the day of the surgery, you’ll receive general anesthesia from an anesthesiologist. This will put you to sleep so you won’t feel pain.

Your surgeon will:

• Make an incision (cut) in your skin near the affected part of your spine that your surgeon will work on.
• Move skin, muscles and ligaments to see your bones better.
• Cut the foramen bone to expand the nerve root opening.
• Perform additional procedures to expand your spinal canal, like a laminotomy or laminectomy if needed. They may also stabilize your spinal column by connecting your bones (spinal fusion).
• Move ligaments, muscles and skin back into place.
• Close the incision site.

How long does a foraminotomy take?

On average, a foraminotomy takes around two hours to complete.

What happens after a foraminotomy?

After a foraminotomy, you’ll likely stay overnight in the hospital for observation. When you wake up, your care team will give you medications to ease discomfort. You should be able to sit up about two hours after surgery.

You won’t be able to drive yourself home from the hospital, so you’ll need to ask someone for help. You should be able to drive within one to two weeks following the procedure.

You’ll need to be very careful about your movements following surgery, especially moving your neck if you have a cervical foraminotomy. Your care team will explain what movements are safe and how you can manage your surgical site when you go home. They’ll also give you instructions to follow to take care of yourself and who to contact if you have any questions or concerns.

Your surgeon will schedule an exam to check how your body is healing a few weeks following the procedure. You may need to see a physical therapist to exercise and strengthen your muscles.

What are the benefits of a foraminotomy?

A foraminotomy relieves nerve pressure. This can improve symptoms like nerve pain, numbness and difficulty moving. It can prevent complications of stenosis like chronic pain.

What is the success rate of a foraminotomy?

One study found that on open and minimally invasive cervical foraminotomies, the success rate was 92% to 94%. Another study found the success rate was 84% to 86%. The success rate measures how well the surgery relieved pain caused by nerve compression two years after the procedure.

What are the risks of a foraminotomy?

Risks of a foraminotomy aren’t common but may include:

• Bleeding.
• Infection.
• Blood clots.
• Nerve damage (weakness, pain, loss of feeling).
• Spinal instability.
• Little to no relief of symptoms or symptoms that return in the future.
• Limited movement of your neck and back.

Your surgeon will discuss these risks with you before your procedure so you can make an informed decision about your health.

How long is recovery from a foraminotomy?

It takes up to a year to completely recover after a foraminotomy. You’ll be able to do light activities four to eight weeks after surgery. Most people go back to work after four to six weeks. Everyone’s body heals differently, so your surgeon will let you know when it’s safe to do certain things like driving, going to work or school and exercising.

When should I call my healthcare provider?

Contact a healthcare provider if you experience any side effects after surgery or concerning symptoms like:

• Skin discoloration.
• Swelling.
• Severe pain.
• Fever.
• Difficulty breathing or swallowing.
• Dizziness.
• Bowel or bladder problems.