In the case of foraminal stenosis exiting nerves in the spinal canal or foramen are being compressed and surgery is used to remove problems that are causing the compression in the area affected. This can be handled in a few different ways. The traditional lumbar decompression surgeries would be a laminectomy, laminotomy, or a foraminotomy. Sometimes a lumbar fusion is required to be performed with one of the above surgeries but often they can be preformed alone. A spinal fusion may be required when too much of the structure that keeps the spine stable is removed while freeing the nerve.
Surgery can be very successful when dealing with foraminal stenosis, in most cases for the leg symptoms. If the nerve has been compressed for an extended length of time or depending on the severity of the nerve compression, permanent nerve damage may have occurred which is often not curable through surgery. Although the relief of the leg pain associated with foraminal stenosis is quite reliable the success rate for back pain relief through surgery is a little less reliable.
There are a few other surgical options other than open back surgery. The foramen can be opened through an arthroscopic procedure without the need for general anesthesia and this can be performed in an outpatient surgical setting.
Foraminotomy: This is a medical operation used to relieve pressure being placed on compressed nerves being affected by the intervertebral foramen. Nerve roots exit the spinal canal through the intervertebral foramen. A foramen in Latin means a hole, opening or aperture and otomy is the act of cutting, incision which forms the term foraminotomy.
In cases where the foramen is being compressed by bone, disc, scar tissue, or excessive ligament development resulting in a pinched nerve a foraminotomy is preformed to relieve the symptoms of nerve root compression.
Foraminal stenosis, herniated disc, bulging disc, nerve root compression (pinched nerve), removal of scar tissue formation, bone spurs, arthritis in the spin, and sciatica can be treated through the use of the foraminotomy procedure.
Foraminotomy – The procedure: After a local anesthetic is administered, a small incision is made and a round Depuy tube is put into the incision. A series of tubes of increasing size are placed over this first tube, one at a time, to slowly create a small opening to the spine. That allows the surgeon to perform the foraminotomy with minimal damage to the surrounding muscles. The muscles are pushed out of the way and are not torn or cut. The last tube is about 18 millimeters in diameter (about as big as a small marker) and inserted through this working tube is the laser, camera, suction, irrigation and other surgical instruments.
Once everything is in place, the surgeon can begin removing the bone and tissue that is compressing the nerve without distress to the patient. Some patients feel immediate relief during the procedure as the nerve is released. When the procedure is complete, the tube is slowly removed, allowing the muscles to move back into place. Occasionally, a stitch or two is needed for the incision.
After 1 - 2 hours of monitoring, the patient (with a companion) is free to go. The patient is generally encouraged to take a long walk the afternoon or evening of their foraminotomy procedure. The patient then returns the following day for a post-operative visit to get clearance from the doctor to return home.
The advantages of having minimally invasive surgery include:
• No general anesthesia
• No hospitalization
• Minimal scar tissue formation
• Outpatient surgical setting
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