Foraminotomy: Anyone have any experience with this procedure?

Hello @rayreich3. Great question about Foraminotomy. You'll notice that I expanded the title of your discussion. I did this so that you can get tips and suggestions from others who may have experience with the surgery. I am also including @jenniferhunter @wilcy, as they have shared experience related to your question.

Can you share why your surgeon recommended Foraminotomy, and what your concerns are?

Yes thanks
I have herniated disks and spinal stenosis which at times pain flares up that I have to stop walking. My main concern is what happened to me when I had knee replacement surgery and I produce an excess amount of scar tissue and they had to go in again and remove the scar tissue but it has never felt the same and my back and hamstrings and calf muscles are all affected because of the continued problems with scar tissue in my knee. What are the side effects of foraminotomy? That’s my concern now.
Raymond

@rayreich3 I am a Mayo cervical spine surgery patient and had a bad disc removed and replaced with a bone spacer with an incision on the front of my neck. The surgical path does affect some of the risks, so that may not be the same for you as it was for me. I found a video that explains a foraminotomy which shows it as an incision on the back of the neck. That is more painful because of more muscle that is cut to get to the spine than a frontal approach according to my surgeon, so the recovery may be longer, and patients who have had the same procedure as me with a rear approach have longer recoveries. The foraminotomy procedure is to remove an extruded disc or bone spurs that are pressing on the nerves where they exit the spine between the vertebrae. That carries risk of damage to the nerve or cutting the nerve. I know that sounds bad, and that is why you need a very good respected surgeon. In my surgery, bone and disc were removed that were compressing my spinal cord, a similar problem on a bigger scale. There are other risks that all surgeries carry such as infection, or pneumonia if you don't get phlegm cleared out of your lungs after anesthesia. If your surgeon is removing an extruded part of a disc and leaves the disc in your spine, it is possible that it can rupture again and recreate that problem. The extruded disc material causes inflammation which then leads to growth of bone spurs in that area. You may want to seek several other opinions about the disc and ask what is likely to happen if the disc is left in the spine and over what time period would they expect to see further changes. You may find that another surgeon would want to remove that disc and also clean out the foramin. You can look to NFL player Peyton Manning as an example. He had a ruptured C5/C6 disc, and at first they just removed the extruded portion, and the disc material extruded again a couple years later. The next procedure was the same as I had, removal and replacement of the disc space with bone. The NFL allows a player to play if only one level is fused, and he was able to play for several more years before retirement.

In my experience, my preparation made my surgery easier for me and my surgeon because I was working with a physical therapist and doing myofascial release to stretch and loosen the tight muscle and fascia in my neck. This has to be retracted during surgery, and if your neck and shoulders are tight to begin with, that will pull harder on everything else during the surgery. My surgery had a risk of swallowing difficulty as well as vocal chord paralysis, and swallowing hurt for a couple weeks, and I had to be careful not to swallow wrong and my voice was hoarse for a couple days. All of that resolved. Muscle spasms are common with neck injuries and after neck surgery, and MFR can help that too when a surgeon clears you for physical therapy. MFR also helps break up the surgical scar tissue.

I see that you asked about scar tissue from surgery, an excellent question. All surgery creates scar tissue and it tends to tighten up where it is attached to muscles which then in turn pull on and move the bones or create pressure on nerves. Multiple surgeries compound this problem and some patients get where they are always in pain because of scar tissue and surgeons don't want to do any more procedures and make it worse. If you had a conservative procedure now, and the problem happened again, you would need another surgery in the same place. This is why you should get another expert opinion somewhere else as to what other procedures should be considered at your stage of spinal deterioration. That might be difficult right now because elective procedures are on hold because of the pandemic, even at Mayo. I am 3 years post-op and I still need to stretch my neck where the incision was because it wants to tighten again. I also have thoracic outlet syndrome which causes neck and shoulder tightness greater on one side and this is adjacent to that area, so I'm always working at trying to get my neck and chest looser so my ribs will expand properly when I breathe. I did have a chest infection right after my surgery because I wasn't good at expelling the phlegm, and that accumulates because of the anesthesia that slows everything down. Other risk factors can be related to other health conditions that a patient has.

Most cervical spine patients complain of shoulder blade pain before and after surgery, and I had that too. Part of that is because the shoulder blade is stabilized by the neck muscles that are connected to the spine and all of that supports the stabilization of your arm when the shoulder blade rotates to raise your arm. My pre-existing spine caused pain was gone immediately after surgery, and my pain was from the surgical path. There will be lifting weight restrictions after surgery. Mine started at 10 lbs max for 6 months. My own recovery was pretty complete at 3 months. I was forgetting that I had surgery, had no pain, and fusion had begun. I did feel pain that was worse for the first 2 weeks, and then got better, and by 6 weeks, I felt pretty good, but had fatigue. It takes longer to get that and strength back depending on how compromised your body was. Your surgeon will need to answer specifically as to what risks you will have. Here is our discussion on MFR.
https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/
https://www.spine-health.com/video/cervical-posterior-foraminotomy-video

Hi
And thank you for all your information.You really seem to know what you are talking about. I will definitely seek two opinions on the surgery. And there is all the issues that you mention for me as well, my worry is: I produced a tremendous amount of scar tissue after my knee replacement that still has not recovered, but it may be other issues about my knee that have not been addressed. Surgery is a roll of the dice. I regret having done the knee surgery. So I am waiting until I cannot take it the pain any more to get the surgery
Thank you so much,
Raymond

Hi Yes thanks for responding. The doctor first suggested that I go to physical therapy, then shots in back to relieve pain and lastly surgery, I did physical therapy, not a great help, I am getting second shot next week, first shot-no relief at all. My concerns are the scar tissue which I produced after my knee surgery. It has been a problem for me as it has affected my calf and thigh muscles which are tightening up and have over worked and are twice as strong as my other leg. In addition all the issues of going under anesthesia and what can happen during and after the surgery itself. I am going to seek a second opinion soon as I can get an appointment.
thanks again.
Any other information would be highly appreciated
Raymond.

If you think you still have scar tissue in the knee, you might try this:
Lie on your back (can do it in bed just before sleeping and again in the am, before getting up, plus any additional times, even stretched out on a sofa; doing it with shoes on some of the time adds some weight. Simply bend your knee up towards your chest and just let the weight of your bent leg keep it bent. If you can, put your hands either under or on top of your thigh of the bent leg with the scar tissue and make it bend a bit more. I did this over and over when I had scar tissue and it helped. Perhaps it will help you. I did not want to do MUA and my OS did not suggest arthroscopic removal. So I simply decided to try gravity. It has been a couple of years and I still do it, and though I now have a normal bend, I still can occasionally feel the scar tissue remnants, but it isn't the constant aggravating presence it once was. Note: If I do the exercise with one leg at a time, I keep the other leg bent with the foot on the mattress/sofa, not stretched out flat; once upon a time, I left the other leg flat, but when doing PT recently for a foot/ankle issue, my therapist said to always keep the other leg bent up, not flat, and it is much better. She also recommended I do this with one leg at a time, not both legs, and my lower back as well as legs like this. Doing standing calf stretches daily has also helped. Good luck.