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Procedure descriptionA minimally invasive foraminotomy is a procedure that is typically done in conjunction with other spinal procedures that can include laminotomy, diskectomy, and possibly other decompressive procedures. In understanding spinal anatomy and how it would relate to a foraminotomy being performed it is best to consider the spine as with having 2 major canals – the spinal canal and foraminal canals. The spinal cord runs vertically down the spinal canal from the brain stem all the way down to the first few levels of the lumbar spine. Along the way, in between each vertebral segment there are natural lateral openings (medically referred to as foramen) that allow nerve roots to branch out to the upper, middle, and lower extremities of the body. If compression exists within the foraminal canals and that compression causes irritation and inflammation of the exiting nerve root, patients can experience radicular symptoms. What we mean when we discuss radicular symptoms is any symptom that is felt in the upper and lower extremities (hands, arms, shoulders, legs, and feet etc) that is being caused by compression that exists within the foraminal and/or spinal canals. The foraminal canals can become narrow for a variety of different reasons. Patients often present with significant degenerative discs and thereby lose disc height. When disc height is lost often times the foraminal canals will become narrow. The patient may also have a bulging or herniated disc which can protrude into the foraminal canal. Bone spurs can also form and encroach upon the nerve roots. Sometimes the patient will have multiple conditions that all add up to severe foraminal stenosis (stenosis is simply a medical term for narrowing). The procedure itself aims to target all of the conditions that contribute to the narrowing of the foraminal canals. Resection of overgrown and thickened ligament, removal of bone spurs, and removal of soft tissues (such as bulging or herniated discs) can be performed during the foraminotomy. When the conditions that were causing the irritation, inflammation, and compression of the nerve root have been remedied through surgery the patient should experience relief swiftly following surgery
When to ConsiderAs with any surgical procedure – a foraminotomy should only be considered after conservative modalities have failed. You may be a candidate for a foraminotomy if you have the following circumstance
- You have been diagnosed with conditions such as spinal stenosis, foraminal stenosis, degenerative disc disease, and bulging or herniated discs
- You have tried other conservative measures such as physical therapy, epidural steroid injections, chiropractic, massage, acupuncture and unfortunately your symptoms have persisted
- You have sensations of pins and needles and/or have weakness or atrophy in your extremities
Recovery from foraminotomyBecause a foramintomy can typically be performed through minimally invasive approach the recovery time is generally much less than that of an open spinal procedure. Following foraminotomy most patients will be able to return to light work within a few days to a few weeks. Although post-operative pain in most cases will be minimal due to the nature of minimally invasive surgery it is always important for a patient to pay close attention to their specific post-operative instructions per their doctor’s recommendations.
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