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Foraminotomy is a surgical procedure which aims to relieve pressure on the nerve roots where they exit the spine.
The spine is made up of individual bones called vertebrae. These vertebral surround and protect the spinal cord, which exits at spaces between each vertebrae called 'foramen'. Should the foramen become narrowed for any reason, this puts pressure on the nerve. This causes pain, numbness, and in the worst cases, loss of sensation and paralysis. Foraminotomy relieves the pressure by making the exit space larger.
Foraminotomy is rarely performed in cats and is a specialist procedure. Referral to a veterinary orthopedic surgeon is required in most cases.
The cat requires advanced imaging, such as an MRI or CT scan, to visualise the foramen and nerve roots. Cases that require foraminotomy are given a general anesthetic. The fur over the relevant area of the backbone is clipped and the skin aseptically prepared.
The surgeon makes an incision over the surgical site. The muscles overlying the vertebrae are bluntly displaced in order to reveal the foramen. Using a burr, the bone is drilled away until the foramen is sufficiently enlarged.
The may be necessary on one or both sides of the vertebra, and in more than one location.
The skin incision is repaired and the patient woken.
Patients requiring foraminotomy are likely to have pre-existing severe pain or lack of sensation. In successful cases, both pain and compression of the nerve roots is alleviated. Whether or not the patient regains full sensation to the area supplied by the nerves depends on how severe the damage was.
Unfortunately, in some cases the area of bone that was debrided away can 'refill'. This means after an initial improvement, the cat may deteriorate a few months later.
The alternative to foraminotomy would be medical management of their pain and discomfort. However, nerve based pain is difficult to alleviate and the patient is liable to remain in some distress.
It is important to restrict movement in the days and weeks following foraminotomy surgery. This allows swelling to subside, which might otherwise lead to the deposition of scar tissue which could narrow the newly widened foramen.
Pain relief may be required in the first few days after surgery, in order to alleviate discomfort.
The costs involved with foraminotomy are considerable. The sophisticated imaging is a prerequisite for surgical planning, with an MRI scan being in the area of $1,000 to $1,500. A consultation with an orthopedic specialist is likely to be $200 to 250. The actual surgery will be $2,000 to $4,000.
For many cats with long-term pain due to narrowed foramen, then surgery can be curative - depending on the nature of the inciting problem. In a percentage of cases, surgery that was successful initially can deteriorate over time because of scar tissue or new bone developing, which fills in the gap.
This is specialist surgery involving the spine. With even the most accomplished surgeon there is always a slight risk of damage to the nerve root or spinal cord which could result in paralysis of the region supplied by that nerve.
However, in cases requiring foraminotomy, not operating could lead to a marked deterioration, pain, and loss of function, which does not respond to medical management.
Conditions such as lumbosacral degeneration or disc disease are spontaneous conditions and difficult to prevent. It should also be noted that many of the conditions linked to narrowed foramen, as significantly less common in the cat than in the dog.
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