Foraminotomy Introduction The Spine and Spinal Stenosis Last reviewed: 10/16/2015

Transcription

1 Foraminotomy Introduction Your spine, or backbone, protects your spinal cord and allows you to stand and bend. Spinal stenosis causes narrowing in your spine. This puts pressure on your nerves and spinal cord and can cause pain. Your health care provider may recommend surgery to treat spinal stenosis. One type of surgery that can help is a foraminotomy. A foraminotomy creates a larger space in your back for the nerves by opening the narrowed part of the spine. If your health care provider recommends surgical treatment for your condition, the decision whether or not to have surgery is also yours. This reference summary will help you understand the benefits and risks of foraminotomy. It discusses spinal stenosis and its alternative treatments, and the benefits and risks of foraminotomy. The reference summary also discusses what to expect after the procedure. The Spine and Spinal Stenosis The spine protects the spinal cord and the nerves that go from the brain to different parts of the body. The spine is formed of solid vertebrae. The vertebrae are separated by softer disks. There are 33 vertebrae in the spine. Nerves passing through the spinal canal leave the spine through windows called foramina. If the nerves get compressed, this causes pain, tingling and numbness in the parts of the body that are controlled by the nerves, such as legs or arms. Disks Vertebra Foramina 1

2 Sometimes the nerves get compressed because of narrowing of the openings they go through. This is known as spinal stenosis. The narrowing, or spinal stenosis, could happen inside the spinal canal. In this case it is called central stenosis. The narrowing of the passages through which nerves pass can also happen in the foramina, the windows through which nerves leave the vertebrae of the spine. This is known as foraminal stenosis. Most cases of spinal stenosis include a combination of central and foraminal stenosis. Causes Changes that happen in the spine as people get older are the most common cause of spinal stenosis. As people get older: Bones and joints may get bigger. The tissues that support the spine may get thick and hard. Bone Spurs Bone spurs may also develop. This is when the vertebrae grow more bone, usually around disks. Arthritis can cause spinal stenosis. Two forms of arthritis may affect the spine: osteoarthritis and rheumatoid arthritis. Osteoarthritis is the most common form of arthritis. It most often happens in middleaged people. It wears away cartilage and may cause bone spurs and problems with joints. Rheumatoid arthritis affects most people at a younger age than osteoarthritis. It can cause joints to swell and can affect internal organs. It is not a common cause of spinal stenosis. Some people are born with conditions that cause spinal stenosis. For instance, some people are born with a small spinal canal. Others are born with a curved spine. Other causes of spinal stenosis are: Calcium deposits on the ligaments that run along the spine. Injuries. Paget's disease, which is a disease that affects the bones. Too much fluoride in the body. Tumors of the spine. 2

3 Symptoms There may be no symptoms of spinal stenosis, or symptoms may appear slowly and get worse over time. In addition, symptoms depend on which part of the spine has the spinal stenosis. Signs of spinal stenosis include: Loss of bladder and bowel control. Numbness, weakness, cramping or pain in the arms or legs. Pain going down the arms or legs. Other signs of spinal stenosis include: Pain in the neck or back. Sexual dysfunction. Weakness of the arms or legs. One serious type of spinal stenosis is called cauda equina syndrome. This happens when there is pressure on nerves in the lower back. Symptoms of cauda equina syndrome may include: Loss of control of the bladder or bowel. Pain, weakness, or loss of feeling in one or both legs. Problems having sex. If you have symptoms of cauda equina syndrome, you should call your health care provider right away. Diagnosis To diagnose spinal stenosis, your health care provider will ask about your medical history and do a physical exam. Your health care provider may also order x-rays. An MRI may be done. MRI stands for magnetic resonance imaging. It is a test that uses a big magnet and radio waves to look at your spine. Your health care provider may order a CT scan. A CT scan is a series of x-rays that give your health care provider a detailed image of your spine. Your health care provider may order a test in which liquid dye is injected into your spinal column and x-ray pictures are taken. This is called a myelogram. 3

4 Alternative Treatments Health care providers always try non-surgical treatments to treat spinal stenosis. When non-surgical treatments fail, surgical ones may be recommended. Examples of non-surgical treatments include: Limiting your activity. Use of a brace to support your back. Physical therapy may also relieve the symptoms of spinal stenosis. Medications can be helpful in decreasing any swelling and inflammation that may be the cause of the nerve compression. Special medications can be injected directly around a specific nerve in the spine to alleviate the pain. When all else fails, your health care provider may recommend surgery known as foraminotomy. The Procedure The operation is known as foraminotomy. It is usually done under general anesthesia. This means you will be asleep during the operation. The procedure usually takes about an hour. Depending on your condition and the surgeon s preference, the operation may either be done in a minimally invasive way or as an open surgery. In the minimally invasive procedure, the surgeon makes a small incision in the skin near the midline of the back. Usually one incision is needed. But if there are many areas to be taken care of, then your surgeon may make more than one incision. Laparoscopic Operation Open Operation A special tube is inserted through the incision all the way to the spine. The surgeon operates through this tube using a surgical microscope. This is called minimally invasive surgery because it has smaller incisions than open surgery. This results in less injury to the muscles and a faster recovery time. 4

5 Once the tube is inserted, the surgeon starts shaving down the bone around the nerves to create more room. The disks are also inspected. Any loose pieces of disk inside the disk space are removed. Sometimes a spinal fusion may also be done. A spinal fusion is surgery that joins, or fuses together, two or more bones in the spine. This can help make the spine more stable after a foraminotomy. Your surgeon may decide during a minimally invasive surgery that it is safer to perform the foraminotomy using open surgery, which requires larger incisions. This is more likely to happen with patients who had previous spine surgery. Your health care provider will tell you how long you are likely to stay in a health care facility. This depends on several factors, such as your age and medical condition. Depending on how well you do, you may go home the day after surgery or within 2 to 3 days. Risks and Complications This operation is safe. But there are several possible risks and complications. These are unlikely. But they are possible. You need to know about them just in case they happen. By being informed you may be able to help your health care provider detect complications early. The risks and complications include those related to anesthesia and those related to any type of surgery. Risks of general anesthesia include: Cut lips and chipped teeth. Headache. Nausea or vomiting. Problems urinating. Sore throat. More serious risks of general anesthesia include: Heart attacks. Lung infections. Strokes. 5

6 Your anesthesiologist will discuss these risks with you and ask if you are allergic to certain medications. Blood clots in the legs can happen due to inactivity during and after the surgery. These usually show up a few days after surgery. They cause the leg to swell and hurt. Blood clots can become dislodged from the leg and go to the lungs where they can cause shortness of breath, chest pain and possibly death. It is extremely important to let your health care provider know if any of these symptoms happen. Sometimes the shortness of breath can happen without warning. Getting out of bed shortly after surgery may help decrease the risk of blood clots in the legs. Some of the risks are seen in any type of surgery. These include: Infection, deep in the disk space, or at the skin level. Bleeding. Skin scars that may be painful or ugly. Other risks and complications are related specifically to this surgery. These are rare. But it is important to know about them. Fluid may leak from around the nerves. This may require another surgery to fix it. If a disk is found to be herniated and is taken out, there is a small chance that the blood vessels may be injured in front of the spine. This may result in bleeding that could be life-threatening. The bowels could also be injured in front of the spine. The nerves themselves could be injured, causing possible: Bowel or bladder problems. Decreased sensation. Paralysis. Weakness. Sexual dysfunction may happen in rare cases. This can be temporary or permanent. A disk could reherniate and scar tissue could form. There is also the possibility that the operation may not decrease pain or improve other symptoms. Rarely, it may even make them worse. 6

7 After the Surgery No repetitive bending, twisting or heavy lifting is allowed in the few weeks following the operation. If you also have a spinal fusion, you may have limited activity for a longer period of time. After this period of relative rest, physical therapy may be needed to allow you to resume your previous activities. During physical therapy, a health care provider will help you exercise your weakened muscles and give you exercises to do at home to strengthen the muscles. Whether or not you will be able to resume all previous activities depends on how well you are doing at the time of your follow-up. Your health care provider will tell you how long it will take before your back is healed and when you can go back to work. This depends on your age, type of work and medical condition, as well as other factors. Summary Your spine, or backbone, protects your spinal cord and allows you to stand and bend. Spinal stenosis causes narrowing in your spine. This puts pressure on your nerves and spinal cord and can cause pain. Your health care provider may recommend surgery to treat spinal stenosis. One type of surgery that can help is a foraminotomy. A foraminotomy creates a larger space in your back for the nerves by opening the narrowed part of the spine. Health care providers always try non-surgical treatments to treat spinal stenosis. When non-surgical treatments fail, surgical ones may be recommended. Depending on your condition and the surgeon s preference, the operation may either be done in a minimally invasive way or as an open surgery. In a foraminotomy, the surgeon makes a small incision in the skin near the midline of the back. Usually one incision is needed. But if there are many areas to be taken care of, then your surgeon may make more than one incision. 7

8 A special tube is inserted through the incision all the way to the spine. The surgeon operates through this tube using a surgical microscope. This is called minimally invasive surgery because it has smaller incisions than open surgery. This results in less injury to the muscles and a faster recovery time. Once the tube is inserted, the surgeon starts shaving down the bone around the nerves to create more room. The disks are also inspected. Any loose pieces of disk inside the disk space are also removed. Your surgeon may decide during a minimally invasive surgery that it is safer to perform the foraminotomy using open surgery, which requires larger incisions. This is more likely to happen with patients who had previous spine surgery. This operation is safe with excellent results. But complications may happen. Knowing about them may help you detect them early if they happen. 8