An operation to relieve cervical spinal nerve compression through a posterior approach is called a foraminotomy. Dr Ball performs foraminotomy using a specialised, minimally invasive technique in most cases. Where this technique is not suitable, a standard foraminotomy operation is performed through a small incision. Both operations relieve a compressed nerve successfully. The difference between the two techniques is the access technique used.
Do you need an operation?
Compression of a nerve in the spine interferes with its function and may cause any of the following :
- pain
- numbness
- weakness
Compression may be due to :
- disc protrusion (also described as a herniation, bulge)
- ligament bulging
- bony spurs (osteophytes)
Surgery aims to remove the pressure and tension on the nerve in order to relieve symptoms.
Patients who have surgery reach full recovery sooner. Most patients who do not have surgery will also reach full recovery but will take longer.
The decision to have surgery should depend on the severity of your symptoms and your ability to tolerate them. The impact of these symptoms should outweigh the potential impact and risks of surgery.
In most cases, surgery should not be performed until an appropriate amount of time (usually six weeks) has been allowed for spontaneous improvement. When symptoms are especially severe, earlier surgery may be performed. If there is progressive weakness, surgery should be performed emergently.
The Operation
Minimally Invasive Foraminotomy
You will be given a general anaesthetic so that you are unconscious throughout the procedure. Using X-ray guidance, a guide wire is directed towards the area where the nerve is compressed. The tissues in this area are gradually spread (rather than cut) to provide access to the spine.
A small amount of bone and ligament is removed to get access to the nerves of the spine. The structures causing compression are removed to create adequate space around the nerve.
At the end of the operation, local anaesthetic is injected to provide additional pain relief. The wound is closed with a dissolving suture under the skin. The general anaesthetic is stopped and you will wake up and be taken to the recovery room.
Click here for more information on minimally invasive foraminotomy.
Standard Microscopic Foraminotomy
You will be given a general anaesthetic so that you are unconscious throughout the procedure. An incision is made in the midline of the back at the affected level. The muscle is cut from its attachment to the spine and dissected off to one side.
A small amount of bone and ligament is removed to get access to the nerves of the spine. The structures causing compression are removed to create adequate space around the nerve.
At the end of the operation, local anaesthetic is injected to provide additional pain relief. The wound is closed with a dissolving suture under the skin. The general anaesthetic is stopped and you will wake up and be taken to the recovery room.
Risks of Surgery
All surgery carries risks. Surgery is undertaken when the potential benefit to the patient outweighs the possible risks.
The risks associated with foraminotomy include :
- general risks : allergic reactions, heart and lung problems, clots in the legs or lungs
- bleeding problems : may require a blood transfusion
- wound problems : infection, scar formation or spinal fluid leakage
- incomplete response to surgery : persistent symptoms
- nerve or spinal cord injury : weakness, sensory change, altered bowel, bladder and sexual function
These may require prolonged hospitalisation, further surgery and delay recovery.
Smoking and Surgery
Smoking is associated with higher risks of anaesthetic and more complications from surgery. There is a lesser rate of surgical success in smokers. Quitting smoking is a difficult process, but there are important benefits to be gained by quitting before surgery.
After Surgery
Going Home
With the use of modern techniques, many patients are able to go home the same day. Some patients may need to stay between 1 to 2 days depending on the nature of the surgery and personal circumstances. Before discharge, you will need to be able to walk short distances, perform basic self care and pass urine.
Early mobilisation and discharge is associated with quicker recovery and less complications.
Medications
Your pain should be controlled with oral medication alone. Constipation can be a side effect of some pain killers, so drink lots of water, eat a healthy. balanced diet and consider the use of stool softeners.
You should continue to take your normal medications as usual. Please discuss restarting 'blood-thinners' such as warfarin, clopidogrel (Plavix) or aspirin with Dr Ball.
Wound Care
Wounds are covered with a sterile dressing following the surgery. This can be removed 5 days after surgery. After this the wound can get wet in the shower.
Wounds are usually closed with dissolving stitches (sutures) under the skin. These wounds are reinforced with sticky (adhesive) strips on the skin. If they get wet, pat them dry with a towel and they will stay sticky. These can be removed after 5 - 7 days.
If staples or outside stitches are used, these can be removed 7 days following surgery by your local doctor.
Do not soak the wound (in a bath or pool) until you see Dr Ball after the surgery.
Please contact Dr Ball or your local doctor if the wound develops increasing redness or discharge, as this could suggest infection.
Activity Restrictions
For the first few weeks after surgery, the following activities must be avoided
- sudden or excessive neck movements
- heavy lifting
Gentle walking is the best activity to maintain fitness and health following anterior spine surgery. Activity should be gradually increased to a daily 30-minute walk.
Physiotherapy should only be started 4 - 6 weeks after surgery.
Follow-up
Dr Ball will see you about 6 weeks after the surgery. Following this you will have appointments at 3 months and 6 months following the surgery.