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Thoracic (dorsal) spineMinimally invasive surgery

Thoracic foraminotomy

Thoracic foraminotomy is considered for patients with back pain that radiates in a band around the chest or abdomen, often described as burning, pressure or cramping along the path of an intercostal nerve. When medication, physiotherapy or nerve blocks no longer provide lasting relief and imaging shows narrowing of the thoracic foramen or a lateral foraminal disc herniation, this surgery opens that channel and frees the nerve through a posterolateral approach, preserving segment stability whenever possible. The goal is to relieve thoracic radicular pain without the need for fusion when feasible, with indication always personalised based on symptoms and imaging.

Spine neurosurgeon in Alicante and Benidorm
More than 20 years of experience in Neurosurgery (since 2003)
Vithas Medimar Hospital Alicante and Hospital Clínica Benidorm
Posterolateral thoracic foraminotomy illustration showing the foramen being opened to release a compressed intercostal nerve root.

What is a thoracic foraminotomy?

Thoracic foraminotomy is a focused surgery that widens the foramen through which a nerve root exits between two thoracic vertebrae. When that channel narrows due to facet arthritis, joint hypertrophy or a lateral foraminal disc herniation, the nerve becomes compressed and causes band-like pain around the chest or abdomen, following the path of the corresponding intercostal nerve.

Unlike a cervical foraminotomy, which is approached from the front or the back of the neck, in the thoracic spine we usually work from behind, using a posterolateral transpedicular approach or a limited costotransversectomy. This lets us reach the foramen without manipulating the spinal cord and, in most cases, without the need to fuse the segment.

It is an anatomically demanding procedure because the space is small and the thoracic cord is especially sensitive. That is why we only consider it when the diagnosis is clear and the radicular pain is genuinely limiting your life. To discuss your case, you can request an assessment with Dr. Ben Ghezala.

Symptoms and warning signs

Patients who may benefit from a thoracic foraminotomy typically describe:

Back pain that radiates in a band around the chest or abdomen, following the path of a rib
Burning, pressure, cramping or tingling along the same strip, sometimes mistaken for heart, lung or gallbladder problems
Pain that does not respond to physiotherapy, anti-inflammatories, neuromodulators or intercostal blocks
Worsening with deep breathing, coughing, effort or sustained postures
Warning signs: leg weakness, gait disturbance, bowel or bladder changes or abrupt worsening of pain

When is this procedure indicated?

Radicular intercostal neuralgia with matching clinical and imaging findings (MRI or CT)
Thoracic foraminal stenosis or lateral foraminal disc herniation compressing the exiting nerve root
Persistent symptoms despite physiotherapy, neuromodulator medication and intercostal blocks
Disabling band-like pain that limits breathing, sleep or daily activity
Pure foraminal compression, without significant instability or central component requiring a wider technique

How is the procedure performed?

1.Preoperative preparation

Includes a detailed clinical assessment, review of MRI and CT to pinpoint the exact level, and planning of the approach (transpedicular or limited costotransversectomy). Fasting rules, medication adjustments, antibiotic and thrombosis prophylaxis are explained, and any questions are addressed before admission.

2.During the procedure

Under general anaesthesia and with the patient prone, we confirm the correct level with fluoroscopy and, when needed, with navigation. Through a small posterior incision we reach the foramen via a posterolateral route, carefully drilling part of the facet, the pedicle or the rib base depending on the case. We release the compressed intercostal nerve root and, if present, remove the foraminal disc fragment. We confirm decompression and close in layers. Most cases do not require fusion.

3.Immediate postoperative period

You spend a short time in recovery before returning to your room. Pain is controlled, leg neurological function and breathing mechanics are monitored, and gentle mobilisation begins within the first hours. Hospital stay is typically 24–72 hours depending on clinical progress.

Recovery after thoracic foraminotomy

Recovery is gradual. Light daily activities can usually be resumed within a few days, and office work between 3 and 5 weeks depending on progress. Physical jobs or those involving chest load require more time.

The band-like pain typically improves in the first few weeks, though the neuropathic component can take longer to settle, especially if the nerve had been compressed for a long time. Gentle respiratory physiotherapy, postural control and avoiding heavy loads and sudden rotations early on support a safe recovery. Fever, disproportionate pain, new leg weakness or bowel or bladder symptoms warrant prompt medical review.

Risks and possible complications

All surgery carries general risks such as infection, bleeding, thrombosis or anaesthesia-related complications.

Specific risks of thoracic foraminotomy include injury to the intercostal nerve root or spinal cord (uncommon), persistence or recurrence of neuropathic pain, pleural injury with pneumothorax when working very laterally, cerebrospinal fluid leak or, in selected cases, segmental instability that may later require fusion. These risks are assessed individually for each patient and discussed during informed consent.

Frequently asked questions

No. Most intercostal neuralgias can be managed with neuromodulator medication, physiotherapy and, in some cases, nerve blocks. We only consider thoracic foraminotomy when there is a clear compression of the nerve root in the foramen, the symptoms match that level and conservative treatment has not worked over weeks or months.
The first step is to confirm the diagnosis. We review the MRI and CT in detail, rule out non-spinal causes (heart, lung, gallbladder, shingles) and, if we confirm foraminal stenosis or a lateral foraminal disc herniation that explains your symptoms, we discuss thoracic foraminotomy as a structured, proportionate option.
In most cases, no. We work through a posterolateral approach removing only the bone strictly needed to free the nerve root, preserving the joint and segmental stability. We only add a fusion when there is pre-existing instability or when achieving good decompression requires removing more bone than usual.
The procedure usually lasts between 90 and 150 minutes, depending on the level and the approach used. Hospital stay is typically 24 to 72 hours, with gentle mobilisation within the first hours and discharge once pain is controlled and neurological function is stable.
Office work is usually resumed in 3 to 5 weeks. Light physical activity, such as walking and breathing exercises, is reintroduced early. Impact sports, heavy loads and sudden rotations are added back gradually based on progress, typically from 8–12 weeks onwards.
Intercostal blocks and radiofrequency treat the nerve without addressing its cause, and are useful as a bridge or when there is no clear compression. Foraminotomy acts directly on the mechanical origin of the problem, opening the foramen and decompressing the root, which generally provides more durable results in well-selected patients.

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Do these symptoms sound familiar?

If you recognise yourself in some of these symptoms and your pain is starting to limit your daily life, we can review your case in a personalised consultation. Dr. Ben Ghezala will assess your clinical history and imaging studies to help you decide the best treatment option for you.

Request a consultation with Dr. Ben Ghezala