By: 7 May 2020
Foraminotomy mainstreaming in neurosurgery – Onset of minimally invasive surgery paving the way

Alice Ajit Mutum, of Future Market Insights, looks at how advanced technologies in the operating room are rapidly changing the practice and science of spine surgery

At the centre of some of the most significant technological transformations in the healthcare industry, operating rooms are proving to be a breeding ground for innovations. Novel technologies such as robotics, advanced imaging sensors and tools, and 3D printing are making once complex, high-risk surgeries, especially spine surgery, now something that is commonplace and standard. These technologies not only help generate large volumes of patient data, but the outcomes also provide patients with a lower risk of infection and better health results.

As with evolving surgical discipline and the promising rise of minimally invasive procedure, lumbar motion preservation technology and neuro-navigation, the practice and science of spine surgery are rapidly changing. In a journey to develop finer-grained understanding of treatment patterns and patient experience, foraminotomy has been gaining significance in the armamentarium of the spine surgeons for decades.

In recent times, the advent of minimally invasive techniques for posterior cervical foraminotomies has enhanced the treatment of cervical foraminal stenosis and expanded surgeons’ capabilities to address a variety of pathologies in the posterior cervical spine.


Microforaminotomy: An evolutionary step

As the spinal column is intended to be mobile; several techniques that preserve spinal motion in the cervical, thoracic, and lumbar spine have been used over the years to treat nerve and disc related problems.

Posterior cervical foraminotomy (PCF) in particular is long utilised and performed unilaterally and bilaterally in one or more levels, or in combination with laminectomy or laminoplasty. It is considered as a safe and effective procedure for the treatment of clinically significant spinal stenosis or foraminal stenosis, resulting from osteophytes or lateral disc herniation.

Although the procedure allows for preservation of stability and mobility as compared to posterior and anterior techniques with spinal fusion, it has been supplanted with anterior techniques in many cases. Limitations of the posterior cervical foraminotomy include the removal of compressive structures that lie anterior to the spinal cord and the nerve roots.

In recent times, minimally invasive techniques for spine surgery have flourished, with an increasing amount of surgeries being performed for a range of degenerative, traumatic, and neoplastic processes. Foraminotomy for spinal stenosis is no exception. Minimally invasive surgery (MIS) in general promises faster recovery, fewer complications and less collateral damage to the healthy organs, which reduce costs and improve outcomes. The diffusion of MIS in foraminotomy space is revolutionising the treatment of cervical spine disease.

The technique is heralding as a reliable method for decompressing the spinal cord and the cervical nerve roots from different pathologies. Further, it results in shorter postoperative recovery with reduced complications as compared to traditional open foraminotomy. Moreover, MIS PCF, or microforaminotomy, reduces the risk associated with anterior cervical approaches, and is most likely to relieve unilateral radicular pain, resulting from foraminal stenosis.


Broadening clinical applications of laser-assisted endoscopic lumbar foraminotomy

Traditional surgical methods for lumbar foraminal stenosis have been limited to total facetectomy and facet-preserving microforaminotomy. With significant technological advancements in the field of spine surgery, an embrace of research had been forthcoming for the use of endoscopic techniques to treat lumbar foraminal stenosis. However, over the years, practical application of these techniques has been limited to soft disc herniation.

Today, technological evolution has enabled selective endoscopic dissection or removal of bone spurs, thickened ligaments, and debris with assisted laser. As a result, clinical application scope of laser-assisted endoscopic lumbar foraminotomy (ELF) is increasing. A study has demonstrated the laser-assisted ELF technique, aiming determination of clinical outcomes of older patients suffering from failed back surgery syndrome (FBBS). The survey revealed that more than eight out of 10 patient respondents experienced excellent results; whereas, nine out of 10 showed considerable symptomatic improvements. The study concluded that this technique, when performed under local anaesthesia, could be safe and a surgical alternative for patients with increased risk of surgical morbidity, with comprehensive revision surgery.


O-arm imaging and navigation systems to reshape the outcome of foraminotomy

In recent years, O-arm has been successfully established as the next generation spinal navigation tool over C-arm that offers intraoperative 2D/3D imaging and navigation of spine surgeries. With opportunities to reduce dosage and complement the surgical workflow, O-arm imaging and navigation systems are progressing in the transvertebral anterior cervical foraminotomy (TVACF) which help in correcting the direction of the keyhole. Additionally, TVACF with guided AR visualisation has proved to be beneficial, as it can preserve intervertebral disc and reduce adjacent intervertebral degeneration.



Alice Ajit Mutum is an experienced market research writer at Future Market Insights, a global research and consulting firm. She works closely with the healthcare research team to serve the needs of clients from across the globe. These insights are based on a report on Spinal Fusion Market and Spinal Stenosis Market of Future Market Insights.

Sabyasachi Ghosh heads FMI’s healthcare, pharmaceuticals and medical devices domain. The insights presented in this article are based on FMI’s research findings on Spinal Fusion Market and Spinal Stenosis Market of Future Market Insights.