What is a Foraminotomy?

Question: The doctor just told my husband that he needs a foraminotomy. I need an explanation of that in layman's terms. No fancy doctor words, just explain it so we can understand what will happen during the surgery.
—El Paso, TXWoman with a confused look on her faceAnswer: No fancy doctor words—I can do that. I also want to encourage you, after you read my explanation of a foraminotomy, to talk to your doctor again. Ask him to explain the procedure—not so you can compare our answers—but because he is the one who will be doing your husband's surgery. You want to make sure you completely understand what he will be doing.

Let's start by breaking the word foraminotomy into two parts:

Foramen: an opening, especially one into or through a bone. In the spine, you have foramen, also called neuroforamen, on both sides of each vertebra (the bones that make up your spine). The spinal nerves pass through these openings, travelling from the spinal cord and out to the various parts of your body.

-otomy: incision into. You hear this ending a lot in medicine: tracheotomy is a well-known example.

A foraminotomy makes the foramen bigger. Since the spinal nerves have to pass through the foramen, if it becomes too small, the nerves can be pinched (a doctor would say compressed). Pinched or compressed nerves can cause a lot of pain, weakness, numbness, and tingling.

Pinched nerves can even cause pain in other parts of the body. For example, some spinal nerves in your low back travel down your legs. If one of them is being pinched as it goes through the foramen, it can transmit pain signals down your legs.

These symptoms of a pinched nerve may sound familiar; your husband probably has some of them.

In performing the foraminotomy, the surgeon will remove whatever is pressing on the nerve in the foramen. He will use special surgical tools, such as a drill or cutting instruments, to decompress the nerve where it is pinched.

Here are some things that can make the foramen smaller and possibly cause a pinched nerve:

  • herniated disc
  • bone spurs, which are bony growths that can develop as you age

By removing the material that isn't supposed to be in the foramen, the surgeon should have created more room for the spinal nerve. The goal of a foraminotomy is to reduce pain caused by the pinched nerve.

Usually the procedure is combined with a laminotomy to provide better access to the nerve. The lamina is a bony plate on the back of each vertebra. Removing part of it can make it easier for the surgeon to address the nerve problems.

Often times a microdiscectomy is also performed at the same time as a foraminotomy. A microdiscectomy removes any part of a herniated disc that's pressing on the nerves. It has that prefix micro- because it's a minimally invasive procedure: it uses microscopic incisions and leads to a faster recovery following surgery.

SpineUniverse has some good articles on foraminotomies and the conditions that can be treated with a foraminotomy. You can read more about them by following the links in the Related Articles section below.