What Is Microforaminotomy?

Minimally invasive spinal decompression surgery can help relieve nerve compression and alleviate back or neck pain.

Reviewed by Jason M. Highsmith, MD

Microforaminotomy is a minimally invasive spinal decompression surgery often performed to relieve compression of spinal nerve roots and/or the spinal cord. During a microforaminotomy, your spine surgeon expands the size of a nerve root pathway—the neuroforamen—by removing bone spurs and/or soft tissue (eg, herniated disc) pressing on a neural structure in the spine. Spinal nerve compression is a common cause of back and/or neck pain.

What is the difference between an open foraminotomy and microforaminotomy?

An “open” foraminotomy is the traditional and original procedure that involves making a surgical incision and cutting through soft tissues, such as muscles, to gain access to the appropriate level of the spine. Open procedures usually mean more post-operative pain and longer healing times.

During microforaminotomy, everything is “micro” or small, including the size of the surgical incision. Specialized instruments include endoscopes and tubular retractors that reduce damage to soft tissue and muscle by separating, not cutting. The goals of surgery are the same as a traditional open foraminotomy except potential benefits include smaller incisions, less blood loss, reduced post-operative pain, and speedier recovery.

Both open foraminotomies and microforaminotomies may be performed in a hospital operating room, outpatient facility or ambulatory surgery center (ASC). Usually, surgery performed in an outpatient or ASC setting means discharge home the same day. However, if you are hospitalized, a microforaminotomy may help reduce your length of stay.

Minimally invasive spine surgeries like microforaminotomy take advantage of the latest medical technology and offer a host of benefits, but not everyone is a candidate for a minimally invasive procedure. Your surgeon will consider your medical history, spinal condition and diagnosis, and treatment to determine if a minimally invasive approach will provide you with a good surgical outcome.

Is the neuroforamen the same as the foramen?

The neuroforamen, which may also be called the intervertebral foramen or simply foramen, are passageways through which your spinal nerve roots exit the spinal canal. The neuroforamen are located on either side between two vertebral bodies (between an upper and lower vertebra).
Also located between each upper and lower vertebra is an intervertebral disc. The disc is the cushion between each vertebra, and disc height dictates the size of the neuroforamen. When a neuroforamen’s size becomes smaller, the spinal nerve passing through becomes cramped and compressed—this causes pain.

What types of spinal disorders does microforaminotomy treat?

Several spine conditions can cause a neuroforaminal space to narrow and compress spinal nerves, including degenerative disc disease, spinal stenosis, and spondylosis (spinal osteoarthritis). Microforaminotomy may be performed to “decompress” the nerve structures and relieve back or neck pain.

How Is microforaminotomy spine surgery performed?

A microforaminotomy is performed under general anesthesia, and one way is using endoscopic spine surgery techniques. Surgery may involve one or more spinal levels (eg, L2-L3, L3-L4) utilizing an endoscope to view the surgical field and a tubular retraction system.

The tubular retraction system involves insertion of a tiny tube through a small incision to gently separate muscles and other soft tissues. Then, a series of progressively larger tubes is inserted, one tube over the other. Progressively, each tube helps to dilate and slowly open a surgical pathway providing access to precise level of the spine. The microforaminotomy is performed through the tube using small instruments.

During this procedure, you may be positioned lying on your stomach (also known as a posterior approach, surgery is performed from the back of your body). Your surgeon will enlarge the size of the affected neuroforamen by removing bone, disc fragments, or any other material that's pressing on the spinal nerve(s).

Depending on the number of spinal levels requiring decompression, this surgery usually takes about 2 hours to perform.

Is foraminotomy a risky surgery?

All surgeries have some risks, such as excessive blood loss during the procedure and infection. And while microforaminotomy offers a host of benefits associated with minimally invasive spine surgery, there are potential complications that you should understand before undergoing the procedure. These complications include:

What about recovery from microforaminotomy spinal decompression surgery?

Most patients experience pain relief after a microforaminotomy and can quickly return to their normal routines. However, your doctor will provide you specific instructions on how to safely return to your daily tasks and gradually engage in more strenuous activities, such as returning to exercise. Precisely following your doctor’s recommendations can help ensure you protect yourself during your spine surgery recovery phase and give yourself the best chance of long-term success.

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