Minimally Invasive Spine Surgery


A foraminotomy, also known as foraminal decompression, is a surgical procedure performed to relieve pressure on a nerve root that exits the spinal cord through an opening called the intervertebral foramen. Narrowing of this foramen is also known as foraminal stenosis. This procedure is typically used to treat foraminal stenosis from conditions such as herniated disc, bone spurs, and other degenerative changes that cause nerve compression in the foramen.

During the surgery, the surgeon removes a small portion of bone or tissue to widen the foramen and alleviate nerve compression, helping to improve symptoms like pain, tingling, numbness, and weakness along the affected nerve pathway. The procedure can be performed using traditional open surgery or minimally invasive techniques, and the recovery time varies depending on individual factors and the surgical approach used.

What is a foraminotomy?

A foraminotomy, also known as foraminal decompression, is a surgical procedure performed to relieve pressure on a nerve root that exits the spinal cord through an opening called the intervertebral foramen. The intervertebral foramen is a small opening between two adjacent vertebrae through which spinal nerves pass to extend to other parts of the body.

Foraminal Stenosis

When there is a narrowing of the intervertebral foramen due to conditions such as spinal stenosis, herniated disc, bone spurs, or other degenerative changes, the nerve root can become compressed or pinched. This compression can lead to pain, tingling, numbness, weakness, and other neurological symptoms along the pathway of the affected nerve.

A foraminotomy is typically performed to address this compression and alleviate the symptoms. During the procedure, a surgeon removes a small portion of the bone or tissue that is encroaching on the nerve root and causing the compression. By widening the intervertebral foramen, the pressure on the nerve is relieved, and the nerve can function properly without being impinged.

Which conditions are treated with a foraminotomy?

A foraminotomy is primarily used to treat conditions that cause compression of spinal nerve roots as they exit the spinal cord through the intervertebral foramen. A narrowed foramen is also called foraminal stenosis. Some of the common conditions that may be treated with a foraminotomy include:

  • Bone Spurs (Osteophytes): These are bony growths that can develop on the vertebrae due to degenerative changes in the spine. They can encroach upon the intervertebral foramen and compress the nerves.
  • Facet Joint Hypertrophy: Enlargement of the facet joints in the spine can also contribute to foraminal narrowing and nerve root compression.
  • Herniated Disc: Also known as a slipped or bulging disc, this occurs when the soft inner material of a spinal disc protrudes out of its normal position and compresses nearby nerve roots.

What happens during the procedure?

The foraminotomy procedure is a surgical intervention aimed at relieving pressure on a compressed spinal nerve root as it exits the spinal cord through the intervertebral foramen. It can be performed using traditional open surgery or minimally invasive techniques, such as endoscopic or microsurgical approaches. Here’s a general overview of the procedure:

  • Anesthesia: On the day of surgery, the patient is placed under general anesthesia, which means they are unconscious and pain-free throughout the procedure. In some cases, regional anesthesia (such as a spinal or epidural block) may be used instead.
  • Incision: For minimally invasive foraminotomies, small incisions, usually around 1-2 centimeters in length, are made near the affected vertebral level. In traditional open surgery, a larger incision is made to access the spine.
  • Decompression: The surgeon carefully removes or trims the bone, ligaments, or other structures that are compressing the spinal nerve root and causing the symptoms. The goal is to widen the intervertebral foramen to create more space for the nerve root.
  • Nerve Root Protection: During the procedure, the surgeon takes great care to avoid direct manipulation or excessive retraction of the nerve root to prevent additional damage.
  • Closure: After the decompression is completed, the incision is closed using sutures or surgical staples. In minimally invasive procedures, the incisions are usually small and may not require sutures.
  • Recovery: After the surgery, the patient is monitored in the recovery room until they wake up from anesthesia. Depending on the surgical approach and individual circumstances, patients may be able to go home the same day or may require a short hospital stay.

What is the recovery time from a foraminotomy?

The recovery time after a foraminotomy can vary depending on several factors, including the specific surgical approach used, the extent of the nerve compression, the individual’s overall health, and their adherence to post-operative instructions.

Hospital Stay

If the foraminotomy was performed using a minimally invasive approach and there were no complications, the patient may be discharged from the hospital on the same day as the surgery or the following day.

Return to Normal Activities

The timeline for resuming normal activities varies, but most patients can usually start walking and performing light activities within a few days to a week after the procedure. However, activities that involve bending, lifting, or twisting may be restricted for several weeks.

What are the risks of a foraminotomy?

Foraminotomy, like any surgical procedure, carries certain risks and potential complications. While it is generally considered safe, patients should be aware of the following risks associated with this surgery:

  • Infection: There is a risk of developing an infection at the surgical site. This can usually be treated with antibiotics, but in some cases, additional medical intervention may be necessary.
  • Bleeding: Excessive bleeding during or after the surgery is possible. Surgeons take measures to control bleeding during the procedure, but in rare cases, additional interventions or blood transfusions may be required.
  • Nerve Injury: Despite the surgeon’s utmost care, there is a small risk of nerve injury during the procedure. This could lead to new or worsened neurological symptoms. Nerve injuries can sometimes be temporary, but in more severe cases, they may be permanent.

Is a foraminotomy right for me?

​​Foraminotomy is generally considered when conservative treatments, such as physical therapy, medications, and rest, have not provided sufficient relief from nerve compression symptoms. It may be recommended if you have conditions like spinal stenosis, herniated disc, bone spurs, or foraminal stenosis, and if the nerve compression is causing significant pain, numbness, weakness, or other neurological deficits.

Before considering any surgical intervention, it is crucial to consult with a qualified healthcare professional, such as an orthopedic surgeon or a neurosurgeon, who can thoroughly evaluate your condition, review your medical history, and perform any necessary imaging studies to determine if foraminotomy is an appropriate treatment option for you.


Gilchrist RV, Slipman CW, Bhagia SM. Anatomy of the intervertebral foramen. Pain Physician. 2002;5(4):372-378.

Evins AI, Banu MA, Njoku I Jr, et al. Endoscopic lumbar foraminotomy. J Clin Neurosci. 2015;22(4):730-734. 

About the Author

Dr. Luke Macyszyn

Dr. Luke Macyszyn is a Board Certified, fellowship trained neurosurgeon that specializes in the surgical treatment of complex spinal disorders such as scoliosis, spinal deformities, and spine tumors in children as well as adults. Dr. Macyszyn currently practices as DISC Sports and Spine Center. He also holds an appointment as an Associate Professor of Neurosurgery at Saint John's Cancer Institute. Prior to joining DISC, Dr. Macyszyn held appointments at UCLA in the Department of Neurosurgery, Orthopedics, and Radiation Oncology. Dr. Macyszyn completed medical school at Boston University and residency at the University of Pennsylvania.