Why is foraminotomy performed?
Foraminotomy is performed to widen foramina have become narrowed or partially occluded due to injury, bone spurs or degenerative changes such as arthritis. When these openings become narrowed or blocked, the nerves that pass through them can become pinched or irritated, resulting in pain in the back or neck and often radiating along the nerve pathway. Foramina can also become occluded by tumors and lesions that require additional surgery to treat, or they may be associated with a herniated disc that protrudes or leaks into the openings, pressing on nerves and causing irritation.
Foraminotomy is generally performed on patients who have symptoms that interfere with their quality of life and daily living. Symptoms can include:
- pain in the leg, shoulder, arms or hands that can be deep and persistent
- numbness of muscle weakness in these areas
- pain when moving or performing specific motions
Before any procedure is performed, imaging tests like magnetic resonance imaging (MRI) will be conducted to confirm the diagnosis and to ensure foraminotomy is the appropriate treatment.
How is foraminotomy performed?
Foraminotomy is performed through a small incision that’s made over the affected portion of your spine. Your muscles and other tissues will be carefully spread apart to expose the foramen that needs to be widened. An special tool called an endoscope will be inserted into the incision, enabling the doctor to see the treatment area and to perform the procedure with instruments designed to be used through small incisions. The endoscope uses a tiny camera to project images to a computer screen so the treatment area can be clearly seen without the need to make a large incision or cut away muscles and other tissues. In addition to the endoscope, x-ray images will also be used in most cases to evaluate the area as the procedure is being performed.
Once the narrowed foramen has been reached, the doctor will carefully remove bone spurs that are impinging on the nerve to widen the opening and relieve pressure on the nerves and surrounding tissues. A small portion of the bone is also removed. When a herniated disc is present, the doctor will also treat the disc to eliminate pressure and irritation it may be causing. In some cases, a procedure called a laminectomy may also be performed to remove another area of the bone called the lamina.
Finally, the area will be cleaned of debris, the instruments will be removed and the incision will be closed with a few sutures.
What is recovery like?
Depending on the extent of your procedure, you may be discharged the same day or you may need to spend a day or two in the hospital. You’ll be given pain medication to minimize your discomfort and strenuous physical activity like heavy lifting will be restricted initially to enable the area to heal. Physical therapy may be part of your recovery process, and if the procedure is performed in your cervical spine (neck), you may need to wear a soft collar during the initial stages of healing. Complete recovery takes about 10 to 12 weeks in most cases.
Will insurance cover the procedure?
Although the procedure is approved by the Food and Drug Administration (FDA), some insurance companies consider foraminotomy to be a novel or new procedure, and they may not provide complete coverage. The best way to determine if your plan covers foraminotomy is to call your plan adviser or ask the staff at your doctor’s office to call your insurer and review your coverage.