Foraminotomy micro surgery

[vinodbajaj]

My 81 years old mother from Ireland with good health has been suffering from pain during walking for past 6  months. MRI was done 4 months ago and met NeuroSurgeon and he diagonsed her symptom one of "Nerve Pinch" at L4/L5 level and suggested Foraminotomy microsurgery to create an extra space between nerve and the bone. He also said that physio and medication will offer very short temporary relief. He also said that he will not go near either soinal cord or nerve. Just scrap bone and create space vis microsurgery. The operation will be non evasive and she could be out of hospital in 2-3 days because of age. Younger folks are out within a day. Neurosurgeon is from a batch of 1983 doctor and Neurosurgeon consultant in University teaching hospital. I have following questions:
1. How good and safe is this technique?
2. Is there a non surgical treatment ? (She is on 150 mg Lyrica twice a day nerve pain medication but not much help)
3. Should I take a second opinion? (MY family doctor said that if his mother had a similar problem he will have NO hesitation in sending her to same Neurosurgeon)
4. Should she go through surgical treatment?

Regards

[vinodbajaj]

Hi Dr. Noopur

Thanks for the prompt response and much appreciated. I did a lot of research through Google on this treatment such as the technique, duration, possible complications and post care.There is still a question in my mind should I seek a second opinion just to be reassured that the first Consultant Neurosurgeon has diagnosed the symptom and treatment.

Her MRI report summary says "Well marked central canal stenosis at L3-L4 and L4-L5 with a grade 1(15%) spondylolisthesis due to degenerative change in the posterior facet joints at the L4-L5 level. Sacroiliac joints are within normal limits". Mum has a lot of pain when she walks (max 20 yds) but OK when she is seated and during sleep. Nerve pain medication such as Lyrica 150mg twice a day and other pain killers such as Zydol and BuTrans patch have not been fully effective).

Questions:

1. Should I seek second opinion? Our Family GP is very confident about the referred Neurosurgeon consultant in the University teaching hospital (Infact GP said that he will send his mother to him if ever required)
2. What happens if the second opinion and treatment is different (highly unlikely but a possibility)  
3. Will Anethesist will be OK with her on the day of treatment because as per Neurosurgeon he can do the foraminotomy microsurgery but Anethesist must be happy with my mum's overall condition for either local or general anethesia prior to surgery (Why?)

The final verdict of first Neurosurgeon consultant was that a lot to gain and nothing to lose. He will NOT be going near either Spinal Cord as it stops at L1/L2 or nerve root. He will just enlarge space at Foramen to create enough space for nerve to move.

I need some reassurance and that's why I'm analysing it in detail. Any views?

Regards, Vinod Bajaj

[DrNoopurMD]

Hi,

How are you?
The goal of foraminotomy is to enlarge the space where the nerve roots exit from the spinal canal. This decreases the pressure on the nerve roots and thereby alleviates symptoms.
Some patients can develop instability of the spine if a large amount of bone needs to be removed. In your mother’s case from your post it seems that only a small amount bone needs to be removed. This should not be a problem if she is in general good health.
Medical treatment of disc herniation is physical therapy and pain medication.