What is Foraminotomy?
The foramen is a part of the spinal column that exists as a bony archway for nerve roots to run through. When these nerve roots become damaged, problems begin to occur with a dog's motor and sensory skills. This is very painful for the dog, and may result in weakness, strange posture or even partial paralysis. Affected dogs will have trouble rising up or jumping, and may even become incontinent.
To treat lumbosacral (lower back) disease, non-invasive measures may first be taken. These include medication prescriptions and strict activity limitations. This is often not a long-term solution, and surgery is generally sought eventually. A foraminotomy is used only when the back pain stems from the narrowing of the foramen. This narrowing is what damages or pinches the nerve roots in some cases. Spinal surgery is complex, and should only be attempted by an ACVS board-certified veterinary specialist.
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Foraminotomy Procedure in Dogs
To assess how much damage exists to the nerve root pathways, an MRI or CT scan will be needed. This can also help the surgeon plan the operation. To measure the epidural space, an epidurography using contrast material can be performed. Full blood work will need to be run before the operation to ensure that the dog is healthy enough to undergo general anesthesia. The dog will be required to fast for several hours preceding the surgery.
To begin the procedure, the dog will be sedated and it's lower back will be shaved and disinfected. An intravenous catheter and endotracheal tube will be placed. General anesthesia can then be administered. Either a medium sized incision or multiple small midline incisions will be made to the area depending on if the surgery is being performed endoscopically or traditionally. The back muscles will be dissected, exposing the spine. All bony and soft tissue that is narrowing the passage will then be removed from the foraminal area using a pneumatic drill. The tissue and skin can then be closed using sutures.
Efficacy of Foraminotomy in Dogs
A foraminotomy can be a successful way of treating lumbosacral stenosis if all bony tissue growths are located and removed. If done correctly, stability of the spine can be maintained. The best results occur if surgery is completed before the animal becomes incontinent. Overall, the prognosis with this surgery is good, with up to 50% of dogs being able to resume all normal activity, and the remaining 50% left with only minor disabilities. If no bony tissue is present, a facetectomy or a dorsal laminectomy should be performed instead.
Foraminotomy Recovery in Dogs
The dog's heart rate and breathing should be monitored as the anesthesia wears off. A CT scan should be performed immediately after the operation has occurred to evaluate how much tissue has been removed. Another scan will be needed approximately 12 weeks later.
The dog will be under strict cage rest for the duration of this time. After 12 weeks, activity can be gradually resumed. Care should be taken while the dog is under cage rest to regularly let it out for leashed breaks to empty its bladder. If not done frequently enough, the dog can develop a urinary tract infection. Physiotherapy can be started once the dog has begun regular activity again.
Cost of Foraminotomy in Dogs
The cost of spinal surgery can be very high. The imaging needed alone can cost up to $1,500. A specialist is generally needed to perform a foraminotomy, which also adds to the price. The total costs can range from $3,000 up to $6,000. Physiotherapy after the operation can be up to $75 per session. Foraminal stenosis can be treated using only medication, however, this is a temporary solution requiring steroid or NSAID prescriptions and lengthened periods of cage confinement.
Dog Foraminotomy Considerations
All surgery that uses general anesthesia brings rare but serious risks to the dog. Spinal surgery is complex and can result in lasting damage. If too much of the foramen is removed, the dog can be left severely unstable. The surgery does not prevent the regrowth of bony tissue. If the dog resumes activity too quickly, the procedure can be ineffective. The majority of dogs that undergo a foraminotomy experience pain relief and are left with decent gait stability.
Foraminotomy Prevention in Dogs
Spotting the early signs of degenerative lumbosacral stenosis will increase the likelihood of a good outcome for your dog. Medium to large breeds are more susceptible to this condition. German shepherd dogs experience this ailment more than any other breed. It generally begins to show itself when the dog is middle to old aged.
Male dogs suffer from foraminal stenosis more than females. Take your dog in for a physical examination if it begins to show any signs of pain, motor dysfunction or weakness. Biting at its tail, feet or rump is another sign of spinal compression in a dog. The earlier that this problem is identified, the less chance there is of the dog needing invasive surgery.