Alternatives to Cortisone injections for foraminal Stenosis

Foraminotomy is done without fusion. It can destabilize the spine after which you may need fusion.
If bone spurs (osteophytes) are the problem those can be removed and might be removed at the same time as a foraminotomy procedure. A lot depends upon what is putting pressure on the nerve.
Radiofrequency of the medial branch nerve would be an option if your primary symptom is pain.

Thanks for the info. I Guess that's why the surgeon said he would have to do fusion if it destabilized me. My main symptom is that my legs twitch pretty badly and it can be painful and keep me awake so I generally don't sleep more than 3 or 4 hours a night and sometimes I won't fall asleep till literally 6:00 AM because I think it takes all night for everything to calm down enough. That is after I was walking around all day doing things.

@annie1
your sleeping position must be aggravating the stenosis. Which is interesting, very interesting. You might try sleeping with a small pillow under your knees or between your knees if sleeping on you side. If you sleep supine a larger pillow so you form a figure four might help. It could be that the day time activities aggravate your back so that it swells a bit at night aided by gravity which moves the fluids to the lowest part of the body. Ice packs might help too, but it seems like it must be positional aggravation.
Do you have a buldging disc, or spondylolythesis.
Your symptoms sound more like central canal stenosis.

I have central canal stenosis and spondylolythesis also ! I already sleep with a pillow under my knees or on my side between my knees. The surgeon says the foraminal stenosis is what is causing the twitching and wants to do fusion surgery which I am afraid of due to my osteoporosis.

annie1, Forteo or Tymlos would make surgery safer for you. You may want to avoid surgery anyway.
The spondylolytheses would make the spine less stable after foramenotomy.
There is a non-fusion surgery https://consultqd.clevelandclinic.org/for-spondylolisthesis-posterior-lumbar-facet-arthroplasty-promises-a-mobility-maintaining-alternative-to-fusion You wouldn't want to consider it without osteomedications, though.
Physical therapy could strengthen muscles and ligaments around the slipping vertebra.

I had a similar situation as Annie back in 1988 and had fusion with laminectomy L5 w/ fusion L4-S1. Mine was done with stainless steel plates and screws which are no longer used. Titanium is a much better choice now used. I have no regrets except I cannot have an MRI.

Did you have Osteoporosis when you had your fusion ? I do and that can be dangerous from what I have read if the bones aren't strong enough to hold the screws and plates in place. How long was your recovery ?

In 1990 I did not have osteoporosis. My recovery was lengthy and I was on SSD for 4 years before returning to work.

My physical therapist suggested sleeping on my back, and surprisingly, that seems to help. I have a sleep number bed (set at 50 usually) and have the head elevated to the Snore position (20-30 degrees?). I spent so many years sleeping on my side, that I still sleep part of the night on my side, but if I wake up and roll back on my back, I go right to sleep. Therapist also recommends I do some lumbar stretches in the bed before getting up in the morning, and that helps a lot. I notice a difference in the stiffness if I don't do those first. I change the bed setting to max firm (100) and do a set of 20 gentle side to side of bent knees, flat back--gentle. And 15 pelvic tilts. And 2 x 6 single bent knee to chest exercises, keeping the other leg/knee bent, not flat (previously, I had been told and seen in ex books to keep the other leg flat, but this PT says for lumbar stenosis, to keep the other leg bent at the knee with the foot on the bed, and it feels different/better). These are not meant to be done as strengthening, but rather, as gentle stretches to loosen up before walking around.

If screws can’t be used, my doc will use cement.