Lumbar Foraminotomy

Lumbar foraminotomy is a surgical procedure to increase the space around one or more neural foramina of the lumbar region, relieving pressure over the spinal nerves. Neural foramen is the space present on either side of the vertebrae through which the spinal nerves leave the spinal canal. Spinal conditions such as stenosis, degenerative disc disease and osteoarthritis of the spine reduce the size of the neural foramen. Furthermore the presence of herniated discs and/or bone spurs, formed due to any of these conditions, constrict the passage in the neural foramen and exert pressure over the nerves. This results in pain, numbness, tingling sensation and weakness in the legs. If non-surgical treatments do not relieve the symptoms, lumbar foraminotomy is recommended.

Procedure

Lumbar foraminotomy is done under general anesthesia with the patient lying in a face down position on the operating table. Guided by intra-operative fluoroscopy, a midline incision is made over the skin of the lower back over the affected intervertebral space.  The back muscles are either cut or retracted to expose the lamina. A small segment of the lamina is removed to reach the neural foramen. A surgical microscope is used to magnify the working area. Microsurgical instruments are then used to remove the disc fragments, overgrown ligaments and bone spurs from the neural foramen. This increases the space around the neural foramen and relieves the compression of the spinal nerves. One or more neural foramina may be operated depending on the individual case. Once completed, the muscles and the soft tissue are placed in their normal position and the incision is closed with sutures.

After the surgery

Patients are discharged a day or two after the surgery depending on the extent of the surgery. Soon after the surgery, most patients experience a significant reduction in the leg pain. However the feeling of numbness, tingling and weakness in the legs improves gradually over a period of time. Pain at the incision site and the spasms of the back muscle are common but resolve within a week or two of the surgery.

Patients are advised to keep their incision completely dry.  Any activity involving lifting, bending or twisting should be avoided. With a few temporary restrictions most patients can resume work within two to four weeks of the surgery.

Risk

All surgical procedures are associated with some risk. Lumbar foraminotomy is a relatively safe procedure but the risk may include infection, bleeding, nerve damage and leakage of spinal fluid.