Do most surgeons often avoid lumbar foraminitomies? All these patients I see with lumbar foraminal stenosis only get a central decompression. Some get better, some have persistent radiculopathy. Another pain doc I know said many surgeons do not like to perform lumbar foraminotomy. Is this true?
A true foraminotomy is a lost art. They were routinely performed by neurosurgeons in the 70s, 80s, and 90s before instrumented fusions became the common surgical technique. (I'm not talking about what surgeons now call a laminoforaminotomy which is really just a laminectomy)
I have spoken with several older neurosurgeons and they say that most residencies don't even teach a true foraminotomy any longer. Unfortunately the reasons they have gone out of vogue are selfish.
1- foraminotomies take a lot of extra time to perform safely
2- higher risk of nerve injury combined with 21st century population much more likely to sue than 20th century patients (it is safer to do a decompression and fusion than just a foraminotomy from a standpoint of individual nerve root injury)
3- For all that work and risk, foraminotomies pay quite poorly compared to a fusion.
4- For reasons 1-3, in many fellowships, particularly ortho spine fellowships, true foraminotomies are no longer even taught.
Unfortunate confluence of minimal tort reform, and poor reimbursement, which results in millions of surgical patients who post op don’t have leg pain, but do have a great deal of unnecessary permanent axial low back pain.
