Lumbar Foraminotomy

The neural foramina are spaces between the vertebrae where nerve roots exit the spinal canal. This space can sometimes become narrowed causing irritation to the nerve. Foraminotomy is a procedure to open up one or more neural foramina thus alleviating pressure and irritation of the nerve root.

The procedure can be done in a number of ways. Traditionally, a midline incision is made over the space to be decompressed. The muscles are retracted to expose the lamina. Often a small opening is made in the lamina to allow access to the spinal canal through which the foramen can be reached. The dural sac is gently moved away from the foramen and held with a retractor. Special instruments are then used to remove bone spurs, overgrown ligament, and other material from the foramen. Periodically, a feeler is used to see how much space has been created for the nerve root. The procedure is finished when enough material has been removed to allow the nerve root to pass through the foramen without being compressed.

Another approach to foraminotomy is what some call "minimally invasive" foraminotomy. In reality, the procedure is very similar to the traditional approach, but instead of a midline incision, a slightly off-center incision is used. Special tubular retractors are passed through the muscle down to the lamina, and the lamina is exposed. From here, the procedure is basically the same as the traditional approach. A potential advantage of the minimally invasive approach is that the incision is smaller, and often more than one level can be done through the same incision. One potential disadvantage is that it can be slightly more difficult to perform the surgery making the operating time longer. In my practice, both procedures are done. I base the approach on where the narrowing is, how many levels are affected, and the anatomy of the patient.