# www.drbarkoh.com llms.txt > Dr Kaku Barkoh is a spine surgeon in Polk County, Montgomery County, Harris County and Angelina County, TX specializing in minimally invasive and non-fusion surgical techniques. - [Dr. Kaku Barkoh | Spine Surgeon Angelina County, TX | Spine Surgery Harris County, TX](https://www.drbarkoh.com/): Dr Kaku Barkoh is a spine surgeon in Polk County, Montgomery County, Harris County and Angelina County, TX specializing in minimally invasive and non-fusion surgical techniques. - [Accessibility | Dr. Kaku Barkoh | Spine Surgeon Harris County, The Woodlands, TX](https://www.drbarkoh.com/accessibility/): Spine surgeon, Dr Kaku Barkoh in Polk County, Montgomery County, Harris County, The Woodlands and Angelina County, TX specializes in minimally invasive spine surgery. 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 Cervical Foraminotomy

What is Cervical Foraminotomy?

Cervical foraminotomy is a surgical procedure performed to relieve the symptoms of a pinched or compressed spinal nerve by enlarging the neural foramen, an opening for the nerve roots to exit the spine and travel through the body. The neural foramen forms a protective passageway for nerves that transmit signals among the spinal cord and the rest of the body parts. Cervical foraminotomy can also be performed through a minimally invasive approach. It does not require cutting and stripping of the muscles from the spine region, unlike the conventional open spine surgery, which requires spine muscles to be cut or stripped.

Indications for Cervical Foraminotomy

Conditions such as herniated discs, bone spurs, and thickened ligaments or joints can narrow the neural foramen and pinch the spinal nerves. A pinched or compressed nerve in the neck region can cause neck pain, stiffness and/or pain, tingling sensation, numbness or weakness that radiates down the arm and hand. If you fail to show improvement with non-surgical therapy, your doctor may suggest cervical foraminotomy.

Cervical Foraminotomy Procedure

Cervical foraminotomy is performed with you lying on your stomach. Your surgeon makes a small incision on the symptomatic side of your neck and approaches the spine by bringing the neck muscles apart using a retractor. Then, the bone or disc material and/or the thickened ligaments are removed, relieving the pressure on spinal nerve structures, creating decompression. The neck muscles are brought back into their original position by removing the retractor. After the procedure, your surgeon closes the incision using sutures.

After Cervical Foraminotomy

Since cervical foraminotomy is minimally invasive, you will usually be discharged on the day of surgery itself, but in some cases, you may need a longer hospital stay. After surgery, the pain symptoms may improve immediately or gradually over the course of time. Compliance with your surgeon’s postoperative instructions may give better results. You will be able to resume your daily activities within a few weeks. Your physician recommends surgery based on your condition and symptoms. Before scheduling the surgery, discuss the benefits, risks, and complications of the surgical procedure with your surgeon.

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 Spinal Stenosis

What is Spinal Stenosis?

Spinal stenosis is a condition caused by the vertebral column constricting and exerting pressure on the spinal cord or neural foramen (a bony tunnel through which a nerve exits the spinal cord).

Spinal stenosis usually affects the cervical and lumbar spine. If the spinal canal is narrowed, the disorder is called cervical/lumbar central stenosis. If the foramen is narrowed, it is referred to as cervical/lumbar foraminal stenosis.

What are the Causes of Spinal Stenosis?

The possible causes for spinal stenosis include:

  • Age: As a result of aging, wear and tear on the spine cause narrowing of the bone.
  • Inflammation of the bone joint such as in osteoarthritis and rheumatoid arthritis may affect the spine.
  • Heredity: Some individuals are born with a narrowing of the spinal canal (congenital). Structural malformations of the involved backbone can cause narrowing of the spinal canal.
  • Spondylolisthesis is a condition in which one vertebra glides forward over the one below causing narrowing of the spinal canal.
  • Tumors of the spine.
  • Injury or trauma may either dislodge the spinal canal or cause fractures that produce bone pieces that may penetrate the canal. At times, injury compresses the nerve roots that can lead to severe pain.

What are the Symptoms of Spinal Stenosis?

Spinal stenosis may result in lower back pain and pain down the legs. The common symptoms include:

  • Numbness
  • Weakness
  • Pain with prolonged sitting or standing
  • Gait disturbances

These symptoms usually gradually progress and worsen over time.

How is Spinal Stenosis Diagnosed?

Diagnosis of spinal stenosis is based on the following: 

  • Medical history: Your physician will gather a detailed history of your symptoms and any treatment received.
  • Complete physical examination: A thorough examination of your body movements is performed by your doctor. Examination of the back is performed to assess for flexibility, range of motion, and the presence of certain signs that suggest nerve roots are being affected by degenerative changes in your back. This is done by testing the strength of your muscles and your reflexes to make sure that they are still working normally. 
  • Investigations: Spine X-rays are radiological tests carried out to rule out other causes such as a tumor or infection. Sometimes, a CT scan or MRI is ordered to get a more detailed examination of the bone or soft tissues. Rarely, Myelography is performed which involves the injection of contrast material into the spine followed by X-rays to detect any pathology of the spine. These tests help in the diagnosis and treatment plan.

How is Spinal Stenosis Treated?

Back pain is treated either surgically or non-surgically depending upon the severity and duration of pain or associated symptoms. The non-surgical treatment options include: 

  • Your doctor may prescribe pain medications and muscle relaxants to relieve pain and inflammation.
  • Rest and restriction of activities that exacerbate back pain.
  • Cold/hot packs to decrease pain due to muscle strains and spasms.
  • Start physical therapy as recommended by your doctor to stretch and strengthen the muscles.
  • Acupuncture treatment for chronic low back pain.

Surgery is indicated only if the pain fails to resolve with these treatments over a significant period. Surgery is carried out to ease pain by relieving pressure on affected nerves. Decompression of the spinal cord accompanied by a discectomy, or an anterior cervical discectomy and fusion will be performed to remove the affected disc and fuse the associated vertebrae to stabilize the spine in that area. Complications of spinal surgery can include excessive bleeding, infection, ongoing pain, nerve damage, or need for additional surgery.

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 Facet Injections

Anatomy of Facet Joints

The facet joints are the tiny joints situated at the upper and lower part of each vertebra, connecting one vertebra to the other. Each vertebra has four facet joints: a pair that connects to the vertebra above (superior facets) and another pair that connects to the vertebra below (inferior facets). They guide motion and provide stability. 

Disease Overview

Pain may arise in the facet joints because of an injury to the back, spinal arthritis or increased stress on the backbone. 

What is a Facet Injection?

A minimally invasive treatment called facet injection offers symptomatic relief from back pain caused by inflammation of the facet joints; however, this is not a permanent solution for the condition. The objective of the treatment is to suppress pain so that normal activities can be resumed and you can perform physical therapy exercises.

Composition of the Facet Injection

A facet injection contains a long-acting corticosteroid and an anesthetic agent administered either directly into the painful facet joint capsule or its neighboring tissues. 

Indications of Facet Injections

The facet injection procedure may be performed primarily as a diagnostic test to determine if the pain is originating from the facet joints. Secondly, it is used to treat inflammation caused by several spine conditions. Facet injection is indicated in conditions where all other conservative treatment modalities such anti-inflammatory medications, rest, back braces and physical therapy have become unsuccessful. 

It may reduce inflammation in the facet joints caused by conditions such as: 

  • Spinal stenosis 
  • Spondylolysis
  • Sciatica 
  • Herniated disc 
  • Arthritis 

This treatment is not appropriate if you have an infection, bleeding disorder or during pregnancy. If you are on aspirin or blood thinners, you will be advised to stop taking them several days prior to the procedure.

Facet Injection Procedure

  • Facet injection is performed as an outpatient procedure where you can return home on the same day, but make sure you have someone with you to drive you home.
  • Usually, the procedure lasts for around 15-30 minutes followed by a short recovery period. 
  • You will be lying face down on a table. Sedatives may be administered to keep you comfortable and a local anesthetic administered to numb the area of injection.
  • Then, your doctor will insert a hollow needle through the skin and muscles into the sensory nerves situated at the facet joints under the guidance of a fluoroscope.
  • Once the position of the needle is confirmed, the medication is injected into your facet joint capsule, following which the needle is withdrawn.

Risks and Complications of Facet Injections

Facet injections are considered as the most appropriate non-surgical means of treatment with minimal risks. The possible risks and complications associated with needle insertion may include bleeding, infection, allergic reaction or damage to the nerves. Some of the adverse effects of the corticosteroid medication include weight gain, water retention, flushing and mood swings, which usually resolve in 3 days.

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