Foraminotomy Risks and Benefits
A foraminotomy can be conducted using minimal access techniques such as endoscopy making the recovery time fairly short, and complications from blood loss or tissue damage less likely. Jaggannathan (2009) conducted a review of 104 patients suffering from radicular pain prior to surgery and found that 95% experienced significant pain relief after the foraminotomy. Other reviews provide similar results (80-90%). Patients often experience immediate improvements in symptoms such as pins and needles and pain. Weakness and numbness take longer to be alleviated with six to twelve weeks common for improvements to be noticeable. A foraminotomy does not remove the need for future surgery and some patients may suffer from a disc protrusion in the same area of the spine, or elsewhere which later requires surgery.
Resolution of the patients’ symptoms depends largely on the extent of damage prior to the foraminotomy as severe nerve damage or severance of the nerve may not be reparable. Alterations in sensations, the return of pain, or a newly developed numbness of weakness should be immediately investigated. On rare occasions a foraminotomy may cause accidental damage to the nerves as they are impacted during the procedure. This can cause permanent nerve damage and chronic pain, numbness, weakness, or paralysis. This is a rare complication but knocking or cutting the nerves remains possible whenever operating near the spine. Additionally, more extensive surgery can lead to neuroma, or nerve-scarring, which may impair nerve function or compress other nerves in the region. Pinched nerve symptoms will then occur. Adhering to post-surgical recovery guidelines will minimize the risks of fibrosis (scarring).
As with any surgery, complications can occur including infection, problems with anaesthesia, and thrombophlebitis (blood clots). Ensuring that the doctors are aware of any medications, prescribed or otherwise, prior to surgery is paramount as the biggest risk with anaesthesia is an adverse reaction to other medications in the system. Alternative medications which may thin the blood (including fish oils, and ginkgo biloba) can also cause surgical complications. Rarely, the patient may react to the anaesthetic itself. Patients at risk of breathing complications are likely to be placed on a ventilator during the procedure in order to keep their respiratory function steady and monitored.
Other advantages of the posterior cervical foraminotomy include the avoidance of any implantation of foreign material in the body, thereby reducing the chances of an immune response as can occur in some disc replacement procedures or vertebral fusion. Mobility of the joints is also retained, again, unlike in fusion where the joints are made more stable but less flexible. In conclusion, posterior cervical foraminotomy is a preferred procedure for many patients and should be considered in the development of a treatment strategy in cases of radicular pain in particular.