Endoscopic Foraminotomy
WHAT IS IT?
In response to wear and tear sustained over the course of a lifetime, the joints in your spine can become overgrown and compress the nerves located nearby that run down to your leg. Endoscopic lumbar foraminotomy removes the overgrown bone and ligament to decompress these nerve roots and relieve symptoms. The most common symptoms are: leg pain (one or both), numbness, weakness, bowel or bladder disturbance and back pain. Surgery is indicated in patients whose symptoms are persistent or becoming intolerable. Generally, surgery is only offered after most conservative options have failed e.g. medication, physical therapy, spinal injections. Early surgery may be performed in patients who have worsening weakness or symptoms suggestive of spinal cord compression.
Healthy spinal canal vs narrowed spinal canal
The illustration on the right visualizes the deterioration of the ligaments, intervertebral discs and facet joints contributing to the continuous narrowing of the spinal canal.
HOW IS THE PROCEDURE PERFORMED?
The surgery will involve a general anesthetic so that you are asleep throughout the procedure. An incision is made on the side of the lower portion of the back where a small port for the endoscope is advanced down to the problem area of the spine. An X-ray is performed to ensure the correct level. Just the right amount of overgrown bone and ligament is removed to free up the nerves and give them room to recover. The endoscope is used to inspect the nerves and ensure there are no remaining areas of compression. Once the surgery is complete, the anesthetic is reversed and you are taken to the recovery room.
Endoscope trajectory for an endoscopic foraminotomy
WHY WOULD FULL ENDOSCOPIC FORAMINOTOMIES BE PREFERRED?
All surgery involves risk and this must be outweighed by the benefits of the procedure. The risks of surgery are related to the anesthetic, operation or hospital stay. Generally, surgery is safe and the risk of a major complication is 1 or 2%. The risks involved with a lumbar laminectomy include: infection, bleeding, failure to improve symptoms, temporary or permanent nerve damage, spinal fluid leak, need for further surgery.
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