Decompression
Foraminotomy
Freeing Pinched Nerves at Their Exit Points
A foraminotomy is a surgical procedure that relieves pressure on spinal nerves by enlarging the foramen—the small openings where nerves exit the spinal canal. Narrowing of these openings, called foraminal stenosis, can cause pain, numbness, tingling, or weakness in the arms or legs. At Desert Spine and Pain, neurosurgeon Dr. David L. Greenwald, M.D., FAANS, FACS performs foraminotomy procedures using microsurgical and minimally invasive techniques whenever possible. This allows patients to recover more quickly, with less pain and smaller scars.
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What Is a Foraminotomy?
In simple terms: A foraminotomy makes the “exit tunnel” for spinal nerves bigger, so they’re no longer pinched.
Scientifically: Foraminotomy involves removal of hypertrophic facet joint, osteophytes, or ligament overgrowth narrowing the intervertebral foramen. It may be combined with laminotomy or discectomy for complete nerve root decompression.
Conditions Treated
Foraminal stenosis (narrowing of the nerve exit canals)
Radiculopathy (sciatica, arm or leg pain from pinched nerves)
Herniated disc with foraminal encroachment
Bone spurs (osteophytes) from arthritis
Degenerative changes causing nerve root compression
Cases where conservative treatments (PT, medications, injections) fail
The Foraminotomy Procedure: Step by Step
Plain-English Overview
Anesthesia: You’re asleep under general anesthesia.
Incision: A small incision is made over the affected area of the spine.
Muscle-sparing approach: Tubular retractors spread muscles instead of cutting them.
Bone removal: Small amounts of bone and ligament are trimmed to widen the foramen.
Nerve decompression: The nerve is freed and confirmed to move without pressure.
Closure: The incision is closed with sutures or glue; patients often walk the same day.
Surgeon-Level Detail
Docking: MIS tubular retractor or open paramedian exposure; microscope/endoscope provides magnification.
Partial facetectomy: Medial portion of superior articular process removed with drill/Kerrisons.
Osteophytectomy: Removal of bony overgrowth encroaching the foramen.
Ligament trimming: Thickened ligamentum flavum or capsule resected.
Disc fragments (if present): Herniated disc material removed to free nerve root.
Confirmation: Nerve root visualized, pulsatile, and decompressed.
Closure: Hemostasis; layered closure; sterile dressing applied.
Benefits of Foraminotomy
Direct relief of pinched nerve symptoms
Preserves spinal stability (minimal bone removal)
Can be performed with very small incisions (MIS)
Often outpatient or 1-night stay
Immediate relief of arm or leg pain for many patients
Risks & Limitations
Infection, bleeding, dural tear/CSF leak
Nerve injury or persistent numbness (rare)
Recurrent stenosis or scar tissue over time
Instability if too much bone removed (fusion may be required in rare cases)
Best for nerve compression symptoms, not isolated back pain
Recovery Timeline
Day 0–1: Walking same day; most discharged within 24 hours
Weeks 1–2: Wound healing; short walks encouraged
Weeks 2–6: Desk work resumed; structured physical therapy may begin
6–12 weeks: Activity expanded; restrictions gradually lifted
3–6 months: Strong recovery; return to normal activity for most patients
Why Choose Desert Spine and Pain?
Expert neurosurgeon: Dr. Greenwald brings decades of experience in microsurgical decompression
MIS focus: Smaller incisions, less muscle trauma, quicker recovery
Tailored care: Surgery only when conservative care fails
Compassionate support: We guide patients step-by-step, reducing the anxiety of spine surgery
Frequently Asked Questions
What’s the difference between foraminotomy and laminectomy?
Laminectomy enlarges the entire spinal canal; foraminotomy targets the nerve exit hole (foramen). They are often performed together if needed.
Will a foraminotomy cure my back pain?
It’s best for nerve symptoms (leg or arm pain, tingling, weakness). Back pain relief is less predictable.
Do I need a fusion with foraminotomy?
Not usually. Fusion is only added if instability is present or develops.
How soon will I feel relief?
Most patients notice immediate improvement in nerve-related pain.
How does Desert Spine and Pain perform foraminotomy differently?
We use microsurgical and minimally invasive techniques to relieve pressure precisely, while preserving stability and promoting faster recovery.
Dr. David L. Greenwald, MD
Neuro-Spine Surgeon
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If you’re struggling with radiating pain, tingling, or weakness caused by nerve compression, a foraminotomy may offer the relief you’ve been seeking. Dr. Greenwald and his compassionate team will carefully evaluate your symptoms, review imaging, and determine whether this minimally invasive procedure is right for you. Every step you take toward specialized spine care brings you closer to comfort and restored function. Schedule your consultation today and let Dr. Greenwald help you regain mobility and live pain-free with expert, precision-guided spinal treatment.
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Over 30 Years Experience in Orthopedic & Neuro Spine Surgeries.
Dr. David L. Greenwald, M.D., F.A.C.S.
Neurosurgeon | Spine Surgeon | Regenerative Medicine
Dr. David L. Greenwald, MD, FACS, is a board-certified spine surgeon with advanced expertise in foraminotomy, a surgical procedure designed to relieve pressure on spinal nerves that exit through the foramina—small openings between the vertebrae. When these openings become narrowed due to arthritis, bone spurs, herniated discs, or degenerative changes, patients can experience pain, numbness, or weakness that radiates into the arms or legs. Dr. Greenwald performs both traditional and minimally invasive foraminotomy procedures using precision-guided techniques to remove the obstruction and decompress the affected nerve. His meticulous approach helps patients throughout South Florida achieve significant pain relief, improved mobility, and long-lasting results with shorter recovery times.
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