22 Apr Minimally Invasive Spine Surgery: Microforaminotomy
Minimally invasive spine surgery has been found to have more advantages over the traditional open spinal surgery. It has been found that minimally invasive keyhole spinal surgery results in less blood loss, decreased hospitalization duration, less pain after surgery, earlier return to activities after surgery and also smaller scars, an important point for those with aesthetic concerns.
Microforaminotomy is a type of minimally invasive keyhole spinal surgery that is also classified as a microdecompression surgery. It aims to relieve the pressure on the spinal cord or nerve roots that are pinched or compressed. This can be due to multiple different reasons such as narrowing of the spinal canal due to degeneration or trauma, herniated or bulging disc that is due to tears of the intervertebral disc (disc between the spine that is rubbery and functions to absorb shock and aids in movement).
Microforaminotomy is a procedure that is used to relieve the pressure on the spinal cord r nerve roots that are compressed. Microforaminotomy aims to achieve the foramen or spinal canal where the nerve roots exit the spine.
In traditional open foraminotomies, it requires the cutting of the back muscles for the surgeons to gain access to widen the foramen of the spine. In minimally invasive keyhole surgery, highly specialized surgical instruments are used to make very small incisions to that damage to the back muscles can be reduced.
As mentioned above, this procedure can be used to treat any causes that may lead to the narrowing of the foramen such as degenerative disc disease, spinal stenosis and arthritis of the spine. All these cases lead to narrowed foramens causing pinched or compressed nerves.
There are 3 main techniques for Microforaminotomy; namely the:
- Mini-open technique – which is similar to an open foraminotomy but in this minimally invasive keyhole procedure, specialized instruments and visualization tools can be used to view the anatomy through smaller incisions.
- Tubular technique – a tube is inserted through a small incision, gently pushing through the back muscles until it reaches the spine. Larger tubes are then progressively inserted to help dilate the area, pushing the surrounding structures even further, opening up the area where surgery will be done.
- Endoscopic – an endoscope (small camera at the end of a tube) is inserted to allow the surgeon to have visual access of the anatomy. Specialized instruments are then used to remove the affected are while the camera streams live enabling the surgeon to see what is going on the whole time.
Patients will be laying prone (on their belly) throughout the entire procedure. General anesthesia will be used and the procedure is usually completed within 2 hours. Since all surgeries carries a degree of risk, there are also some potential risks associated with microforaminotomy, such as: inadequate pain relief, damage to surrounding structures in the spine such as nerves and blood vessels, and the possibility of an additional surgery to correct any complications.
Most patients recover uneventfully and is able to return early to their routines. Rehabilitation after surgery may be necessary.
- Highsmith JM. What is microforaminotomy? Spine Universe. https://www.spineuniverse.com/treatments/surgery/minimally-invasive/what-microforaminotomy. 3/8/2017.
- Lumbar spinal stenosis: patient information. American Association of Neurological Surgeons. 2016. http://www.aans.org/en/Patient%20Information/Conditions%20and%20Treatments/Lumbar%20Spinal%20Stenosis.aspx. Accessed 3/8/2017.