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A Foraminotomy is a back surgery procedure used to enlarge the opening through which a spinal nerve passes as it exits the spinal canal. These openings in between the vertebrae are called Neuroforamen. When this opening is reduced due to a spinal problem or injury, there is less room for the nerves to pass between the bones. This sometimes causes a pinched nerve and the usual painful symptoms.
Anatomy
What parts of the neck are affected?
The spine is made of a column of bones. Each bone, or vertebra, is formed by a round block of bone, called a vertebral body. The spinal canal is a hollow tube formed by the bony rings of all the vertebrae. The spinal canal surrounds and protects the spinal cord within the spine. There are seven vertebrae in the neck that form the area known as the cervical spine. The vertebrae are separated by intervertebral discs.
Traveling from the brain down through the spinal column, the spinal cord sends out nerve branches through openings on both sides of each vertebra. These openings are called the neural foramina. (The term used to describe a single opening is foramen.)
The intervertebral disc sits directly in front of the opening. A bulged or herniated disc can narrow the opening and put pressure on the nerve. A facet joint sits in back of the foramen. Bone spurs that form on the facet joint can project into the tunnel, narrowing the hole and pinching the nerve.
Foraminotomy Procedure
The surgeon can choose 2 methods of doing this procedure. It can be a full open surgery, under general anesthesia. This would include spinal incision, muscle dissection, and possible laminectomy, to remove additional bone. If the surgeon is trained in minimally invasive procedures, then the operation can be done with an endoscope. This will save the patient much recovery time, pain and damage to healthy tissue.
The surgeon will access the problem area and use sophisticated tools to carefully enlarge the neuroforamen, thereby decompressing the spinal nerve root. When the foraminal opening is large enough to once again allow healthy nerve signal, the surgeon will close the incision.
Foraminotomy: Example
One example of a foraminotomy is a keyhole foraminotomy. This is a minimally invasive procedure in which an incision is made in the back of the neck, the muscle peeled away to reveal the bone underneath, and a small hole cut into the vertebra itself. Through this hole, the foramen can be visualized, and the impinging bone or disk material removed, causing the Spinal Stenosis.
Complications
What Might Go Wrong?
As with all major surgical procedures, complications can occur.
Some of the most common complications following foraminotomy include : -
Problems With Anesthesia
Thrombophlebitis
Infection
Nerve Damage
Ongoing Pain
This is not intended to be a complete list of the possible complications, but these are the most common.
Infection
Infection following spine surgery is rare but can be a very serious complication. Some infections may show up early, even before you leave the hospital. Infections on the skin's surface usually go away with antibiotics. Deeper infections that spread into the bones and soft tissues of the spine are harder to treat and may require additional surgery to treat the infected portion of the spine.
Nerve Damage
Any surgery that is done near the spinal canal can potentially cause injury to the spinal cord or spinal nerves. Injury can occur from bumping or cutting the nerve tissue with a surgical instrument, from swelling around the nerve, or from the formation of scar tissue. An injury to these structures can cause muscle weakness and a loss of sensation to the areas supplied by the nerve.
Ongoing Pain
Many patients get nearly complete pain relief from the foraminotomy procedure. As with any surgery, however, you should expect some pain afterward. If the pain continues or becomes unbearable, talk to your surgeon about treatments that can help control your pain.
After Surgery
What Happens After Surgery?
Patients are usually able to get out of bed within an hour or two after surgery. Your surgeon may have you wear a soft neck collar. If not, you will be instructed to move your neck only carefully and comfortably.
Most patients leave the hospital the day after surgery and are safe to drive within a week or two. People generally get back to light work by four weeks and can do heavier work and sports within two to three months.
Outpatient physical therapy is usually prescribed when patients have extra pain or show significant muscle weakness and deconditioning.
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A Foraminotomy is a back surgery procedure used to enlarge the opening through which a spinal nerve passes as it exits the spinal canal. These openings in between the vertebrae are called Neuroforamen. When this opening is reduced due to a spinal problem or injury, there is less room for the nerves to pass between the bones. This sometimes causes a pinched nerve and the usual painful symptoms. 
