GENERAL
Microforaminotomy is the minimally invasive surgical enlargement of the constricted intervertebral foramen. It is a procedure aiming at decompression of the spinal nerve which exits the spinal cord through the narrowed foramen.
The procedure used to be done following the classical surgical method. With the minimally invasive surgical technique, the same result is achieved as with the older classical technique, but with much less injury of the tissues surrounding the surgical area.
Postoperative recovery is very fast with less postoperative pain and the patient returning to physical activities within a short period of time
The technique is applied with the use of very specialized and modern technological and material equipment allowing the surgeon to perform the procedure by making minimal skin incisions.
DISEASES CAUSING INTERVERTEBRAL FORAMINAL STENOSIS
- Intervertebral disc degeneration
- Spinal stenosis
- Spondyloarthritis
Intervertebral foraminal stenosis causes compression on the respective exiting nerve, resulting in inflammation and pain (radiculitis). Surgical decompression relieves the nerve and stops pain.
TECHNIQUE
The technique can be applied in three ways:
- Mini-open. The surgeon makes as small incision through which s/he uses special instruments and a microscope.
- Tubular. During this technique, the spine is approached through an opening (and not an incision) in paraspinal muscles with a tubular dilator inserted into the skin through a very small incision. The tubular dilator serves as a “tunnel” through which special instruments pass for the application of the technique. The advantage of this method is the atraumatic approach to muscles, minimization of blood loss and the impressively rapid postoperative recovery and mobilization of the patient even on the very same day.
- Endoscopic. This technique is performed with the use of a micro camera called “endoscope” reaching the spine through a minimal skin inscision. The surgical field is shown on a monitor situated next to the surgical table. The surgeon performs the procedure by using special instruments while watching through the monitor and advancing them through a working cannula.
The surgical procedure is conducted under general anaesthesia. It lasts approximately two hours. Hospitalisation is needed for one to two days.
RISKS – COMPLICATIONS
As in all surgical procedures, there is the risk for infection and there is also risk for injury of the nerve, spinal cord or vessels of the area.
If not enough bone has been removed and, therefore, there is not sufficient space for the nerve to pass through, pain may recur.
In some cases, there may occur postoperative spinal destabilization, because a large part of the bone had to be removed to achieve effective nerve decompression. If so, there may be need for revision spine fusion to restore spinal stabilization.
A small percentage of patients are likely to present the so-called “Failed Back Surgery Syndrome” (FBSS) with permanent postoperative spinal neuropathic pain, due to nerve root dysfunction of unknown aetiology despite the fact that the surgical procedure was performed perfectly well without any complications.
