Foraminotomy and facetectomy
Nerves in the lumbar spine are often compressed in the
neural foramen, where they leave the spinal canal. These compressions
may be due to arthritic degenerative changes within the
facet joints, or may be the result of slippage or
spondylolysthesis of one
vertebral body segment upon the other. Often, foraminal stenosis is
seen as part of the bigger picture of lumbar spinal stenosis.
For an isolated level of foraminal stenosis,
conservative measures may be best. If surgery is desired, then the
appropriate surgical intervention may depend upon what the larger disease
process is. If one is dealing with a slip of one vertebral body upon
another, then it may be necessary to perform a facetectomy, which involves
removing the facet joint beneath which the exiting nerve root passes, to free up
the nerve. Sometimes, only a "partial" or "medial" facetectomy is
required. Sometimes one can get by with a "foraminotomy" which is an
opening of the foramen (opening in the bone, beneath the facet joint,
through which the nerve travels) with bone biting instruments (known as Kerrison
rongeurs, or foraminotomy punches), but often such a limited operation may
result in disappointing recurrences of the problem.
When a facetectomy is performed, the entire joint is
removed, and the surgeon must decide whether or not to fuse the spine at
that level. |
