If lumbar back pain is due to pinched nerves with evidence of osteophyte growth in the foramina then a lumbar foraminotomy is the most likely treatment. Some people may have congenitally narrow foramina making lumbar spinal stenosis more likely. A foraminotomy involves the use of a burr, or small surgical saw, to shave off the outer edge of the foramen and decompress the spinal nerves. This can have the effect of almost instantly relieving the symptoms of lumbar spinal stenosis, although some residual numbness, weakness, and pain is usual as the nerve heals. For those with a longer history of nerve compression the pain may never subside as permanent damage has occurred.
A foraminotomy is usually an open lumbar back surgery procedure, but more minimally invasive techniques allow some patients to undergo a microforaminotomy under local anaesthetic. These patients will be mobile very quickly after the procedure and have a much shorter recovery time compared to those undergoing a traditional foraminotomy. Most patients will be back at work within two to four weeks and have little risk of complication requiring further lumbar surgery. The difficulty with a microforaminotomy is that the surgeon may have difficulty assessing the level of decompression achieved during the procedure and there may be residual material, such as disc fragments or bone spurs, which continue to pinch the spinal nerves and cause pain.
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