Foraminotomy

When a nerve is being squeezed as it leaves the spine, enlarging the opening it passes through can often correct the problem, relieving arm or leg pain without a fusion.

What Is a Foraminotomy?

A foraminotomy is a surgery that widens a foramen, the small opening on each side of the spine where a nerve root exits the spinal canal. When that opening narrows, a condition called foraminal stenosis, the nerve gets pinched. That can cause pain, numbness, tingling or weakness that travels into the arm (from the neck) or the leg (from the lower back).

The foramen usually narrows because of bone spurs, arthritis in the facet joints, a bulging or herniated disc, or a collapsed disc space. A foraminotomy removes the bone or tissue that is crowding the nerve so it can move freely again.

Foraminotomies can be done in the neck (cervical) or lower back (lumbar). Dr. Grunch often performs them through a minimally invasive approach, and they can be combined with a laminotomy or microdiscectomy.

Who Needs a Foraminotomy?

• Arm pain, numbness or weakness from a pinched nerve in the neck (cervical radiculopathy)
• Leg pain, numbness or weakness from a pinched nerve in the lower back (sciatica)
• Symptoms that haven’t improved with physical therapy, medications or injections
• Imaging that shows a narrowed foramen at the level that matches your symptoms

A posterior cervical foraminotomy can be a motion-preserving alternative to a fusion for some patients with one-sided arm pain. When the problem is a disc in the front of the neck, Dr. Grunch may recommend cervical disc replacement or ACDF instead.

Treatments to Try First

• Physical therapy: exercises and posture work to take pressure off the nerve
• Medications: anti-inflammatory medications, short courses of oral steroids or nerve pain medications
• Injections: selective nerve root blocks or epidural steroid injections to calm the nerve

When these don’t bring lasting relief, or the nerve is losing strength, surgery can often correct the problem.

How a Foraminotomy Is Done

1. Anesthesia: You’ll be fully asleep under general anesthesia, positioned face down.
2. A small incision: Using X-ray to confirm the level, Dr. Grunch makes a small incision on the back of the neck or lower back.
3. Gentle access: The muscles are gently separated, often with a small tube-shaped retractor.
4. Widening the opening: Under magnification, part of the facet joint, bone spurs and thickened ligament are carefully removed to enlarge the foramen. Any disc fragment pressing on the nerve can be removed too.
5. Protecting stability: Most of the facet joint is preserved, so the spine stays stable.
6. Closing: The skin is closed with dissolvable stitches and skin glue.

This animation shows how a posterior cervical foraminotomy is performed:

Click here to accept Marketing cookies and load this content

Posterior cervical foraminotomy animation, courtesy of Swift Institute

Benefits and Risks

Benefits

• Relief of arm or leg pain for most patients
• Preserves motion, with no fusion or implants
• A small incision and usually same-day discharge

Risks

• A small tear in the lining around the nerves (a spinal fluid leak)
• Infection or bleeding
• Nerve irritation or injury, which is uncommon
• Symptoms returning if the opening narrows again over time
• Neck or back muscle soreness for a few weeks
• Risks related to anesthesia

Why Choose Dr. Betsy Grunch for Your Foraminotomy

• Duke-trained: Dr. Grunch completed her neurosurgical residency and a spine research fellowship at Duke University School of Medicine, one of the top neurosurgery programs in the country, where she received the Spine Young Investigator Award.
• Minimally invasive by design: Minimally invasive spine surgery is one of her signature areas. She works through the smallest opening that will safely do the job, so you can get back on your feet sooner.
• Experience you can count on: She has been in practice since 2013 and performs 400 to 600 surgeries a year, more than 5,000 procedures over her career.
• Motion-preservation expertise: She performs foraminotomy as well as cervical and lumbar artificial disc replacement, so fusion isn’t your only option.
• Second opinions and revisions: She regularly sees patients who had spine surgery elsewhere and want a second opinion or need a revision.
• A teacher at heart: As “Ladyspinedoc,” she is known for explaining spine conditions clearly. You’ll leave your visit understanding your imaging and every option in front of you.

What to Expect

Before surgery

You’ll meet with Dr. Grunch or one of her physician assistants to review your imaging, your exam and your goals, and to decide together whether a foraminotomy is right for you. Our team will coordinate any pre-operative testing, review your medications (including blood thinners you may need to pause) and walk you through the day of surgery so nothing is a surprise. If you smoke or use nicotine, stopping before surgery lowers the risk of complications.

Procedure day

A foraminotomy usually takes about an hour per level. Most patients go home the same day with a responsible adult to drive them.

Recovery timeline

• First days: Arm or leg pain often improves quickly. Muscle soreness at the incision is normal.
• First two weeks: Walk every day and avoid heavy lifting. Many people with desk jobs return to work within one to two weeks. Your first follow-up is about two weeks after surgery.
• Two to six weeks: Gradually increase your activity. Dr. Grunch may start physical therapy.
• Six weeks and beyond: Most patients return to normal activities. Numbness and strength can keep improving for several months.

Every patient heals differently. Your exact timeline will depend on your symptoms, your job and your overall health.

Download your patient instructions (lumbar foraminotomy)

If you’re having a foraminotomy in your lower back, print these sheets or save them to your phone so you have them before and after surgery:

• Preparing for surgery: Lumbar Laminectomy (PDF)
• Post-operative guidelines: Minimally Invasive Lumbar Surgery (PDF)

You’ll find instructions for other procedures on our Patient Resources page.

Frequently Asked Questions

Will I need a fusion?

No. A foraminotomy removes only enough bone and tissue to free the nerve and keeps your spine’s motion.

Is a foraminotomy done in the neck or the back?

Both. The idea is the same in either place: widen the opening so the nerve isn’t squeezed.

How soon will my arm or leg pain go away?

Many patients notice improvement soon after surgery. Numbness and weakness can take weeks to months to recover.

Can the opening narrow again?

It can, because arthritis can continue over time, but most patients have lasting relief at the treated level.

When can I drive and go back to work?

You may drive once you’re no longer taking narcotic pain medication and can turn your head or move comfortably, often within one to two weeks.

Take the First Step Toward Relief

A pinched nerve can make it hard to work, sleep or enjoy daily life. Whether you need a treatment plan, a second opinion or a clear explanation of your imaging, Dr. Grunch and the Southern Neurosurgery team are here to help.

Call 470-293-9800 to schedule an appointment or contact us online.

Have a question first? Ask our virtual assistant anything, 24/7.

We see patients across metro Atlanta and North Georgia at our offices in Gainesville, Sandy Springs and South Atlanta (Riverdale). Find the office nearest you.

Related pages: Foraminal stenosis · Cervical radiculopathy · Sciatica · Laminotomy · Cervical disc replacement

This page is for educational purposes only and is not medical advice. It does not replace individualized care from a licensed physician. Please talk with your own doctor about your symptoms. If you have bladder or bowel changes, groin numbness or rapidly worsening weakness, call 911 or go to the nearest emergency room.