Index
It is the narrowing of the openings between the bones of the spine.
These small openings are called foramen. Foraminal stenosis is a specific type of spinal stenosis .
Nerves pass through the foramen from your spinal cord to the rest of your body. When the foramen gets closer, the nerve roots that pass through them can get pinched. A pinched nerve can lead to radiculopathy, or pain, numbness, and weakness in the part of the body that the nerve serves.
Foraminal stenosis and pinched nerves are common. In fact, nearly half of all middle-aged and older people have some form of spinal stenosis and pinched nerves.
But not everyone with foraminal stenosis will experience symptoms. Some people may have symptoms that come and go.
Causes
You are more likely to develop foraminal stenosis and pinched nerves as you age. Arthritis and the wear and tear of daily life often lead to changes in the spine that narrow the foramen.
But injuries can also cause strictures, especially in younger people. For example, one cause of foraminal stenosis is a bulging or herniated disc.
These cushioning discs between your spinal bones can slip out of place or become damaged. The bulging disc presses on the foramen and the nerve root. This is most likely to occur in the lower back.
Bony growths in and around the foramen can also pinch the nerves. The bone spurs are formed due to injury or degenerative conditions such as osteoarthritis. Age-related spinal decline is the main cause of foraminal stenosis.
However, many factors can exacerbate or accelerate the narrowing of the foraminal canals, including:
- Herniated or bulging discs.
- Arthritis.
- Aging of the joint.
- Swelling of the joints
- Accident-related illnesses, such as those that can be caused by falls, sports accidents, or motor vehicle accidents.
- Repetitive strenuous movements or improper lifting, commonly associated with highly physical jobs that require manual labor or professions that involve regularly driving long distances.
- Excessive weight or obesity.
- Smoke.
- Lack of exercise.
- Inappropriate footwear.
- Family history or genetic predisposition.
If you think you may be at risk for developing foraminal stenosis, schedule a consultation with a spinal specialist to discuss what preventive measures may work best for you.
By making minor lifestyle changes and proactively treating problems as they arise, spinal degeneration can be managed, delayed, or even alleviated.
Other less common causes of foraminal stenosis include:
- Enlargement of the ligaments around the spine.
- Spondylolisthesis.
- Cysts or tumors
- Bone disease
- Genetic conditions, such as dwarfism.
Symptoms
The symptoms of foraminal stenosis vary depending on which area of the spine experiences a problematic narrowing (cervical, thoracic, or lumbar), as well as the severity of the problem.
However, there are some general symptoms to look out for, including:
- Pain and discomfort that localize or radiate to the nearby extremities.
- Muscular weakness.
- Tingling sensation.
- Unexplained symptoms in the neck, shoulders, arms and hands (if the narrowing occurs in the cervical or thoracic spine).
- Lumbar, hips, buttocks, legs, or feet (if a foraminal canal in the lumbar spine becomes blocked).
- Sciatica.
- The inability to participate in daily activities without encountering aggravation.
Because the symptoms of foraminal stenosis are also associated with many other disorders and conditions, it is important to seek a complete and accurate diagnosis right away.
To understand the different types of foraminal stenosis, it is best to first understand what foramina are and where they are located.
Holes are side corridors between vertebrae that allow nerve roots to pass from the spinal canal to the body.
Foraminal stenosis occurs when one or more foramines begin to narrow, which can put pressure on the nerve root that passes through it.
While foraminal stenosis is quite common, it is possible to have this condition without knowing it. This is because generally, until the narrow passage compresses a nerve root, the person will not experience symptoms.
Sometimes foraminal stenosis can be accompanied by stenosis of the spine itself. When the spinal cord is compressed, the symptoms can be more severe than when the nerve roots are pinched.
These symptoms can include:
- Clumsiness.
- Problems using your hands.
- Dificulty to walk.
- Soft spot.
Types of foraminal stenosis
Although foraminal stenosis can occur anywhere along the spine, the location of symptoms can help identify where the stenosis has developed.
Foraminal stenosis can occur in any of the three main regions of the spine:
- Cervical (upper) region. This part of the spine that runs through the neck can cause symptoms in the head, neck, arms, and shoulders. Thoracic region (middle).
- The mid-spine can produce symptoms around the ribs, chest, or stomach. Foraminal stenosis in this area is less common due to the relative stability of this area.
- Lumbar region (lower). Lumbar foraminal stenosis often causes symptoms in the lower back, buttocks, legs, and feet.
Symptoms vary on a case-by-case basis. However, pain, tingling, numbness, and muscle weakness are the most common indicators of foraminal stenosis.
Cervical stenosis
It develops when the foramen in your neck narrows. Pinched nerves in your neck can cause a sharp or burning pain that begins in your neck and travels up your shoulder and arm. Your arm and hand may feel weak and numb like “pins and needles.”
Thoracic stenosis
It develops when the foramen in the upper back narrows. Pinched nerve roots in this part of the back can cause pain and numbness that wrap around the front of the body. This is the least common area that is affected by foraminal stenosis.
Lumbar stenosis
It develops when the foramen of the lumbar region narrows. The lower back is the section of your spine most likely to be affected by foraminal stenosis. This can feel like pain, tingling, numbness, and weakness in the buttock, leg, and sometimes foot.
Sciatica is a term you may have heard for this type of pain. Your pain may be made worse by certain activities such as bending, twisting, stretching, coughing, or sneezing.
How to prevent foraminal stenosis?
Foraminal stenosis cannot be prevented, but staying physically active and maintaining a healthy weight can help lower your risk.
Using good posture and technique when sitting, playing sports, exercising, and lifting heavy objects can also help prevent back injuries. Injuries can lead to stenosis and pinched nerves.
Diagnosis
If you have pain that radiates down your arm or leg or a feeling of numbness that lasts for several days, you should see your doctor.
At your appointment, your doctor will begin with a physical exam. He will check your movement, muscle strength, level of pain and numbness, and reflexes.
Your doctor may order some imaging studies and other tests to confirm the diagnosis:
- X-rays can be used to see the alignment of the bones of the spine and the narrowing of the foramen.
- Magnetic resonance imaging can detect damage to soft tissues, such as ligaments and discs.
- CT scans can show more detail than X-rays, allowing your doctor to see bone spurs near the foramen.
- Electromyography and nerve conduction studies are done together to see if your nerve is working properly. These tests help your doctor determine if your symptoms are caused by pressure on the spinal nerve roots or by another condition.
- Bone scans can detect arthritis, fractures, infections, and tumors.
Your doctor or the radiologist who reads your magnetic resonance imaging (MRI) can assess the level of narrowing of your foramen.
Grade 0 = no foraminal stenosis.
Grade 1 = mild stenosis with no evidence of physical nerve root changes.
Grade 2 = moderate stenosis without physical changes to the nerve root.
Grade 3 = severe foraminal stenosis showing nerve root collapse.
What treatment options are available?
Depending on the cause and severity of your foraminal stenosis and pinched nerves, there are several treatments available to alleviate your discomfort.
In many cases, pinched nerves, especially in the neck, will improve without treatment other than stretching, activity modification, and pain-relieving medications.
If you’ve seen a doctor for these painful effects, you’ve likely considered traditional foraminal stenosis treatments, such as pain medication, massage, or open back surgery.
But if traditional treatments haven’t worked for you, or you’ve experienced failed back syndrome, it may be time to explore one of the minimally invasive spine procedures.
Minimally invasive spine surgery works to relieve pain and symptoms of foraminal stenosis by removing pressure on the pinched nerve in the foraminal canal.
This can be accomplished through two types of surgery: decompression or stabilization, although for many patients, decompression surgery is the most appropriate method of treatment for moderate foraminal narrowing.
Stabilization surgery is only used to treat conditions that threaten the stability of the spine. To help patients find peace of mind about spinal surgery, these procedures offer a safer and more effective alternative to traditional open back surgery.
Activity modification
If you have the pain, numbness, and weakness of a pinched nerve, you may want to rest for a few days. But don’t stay inactive for too long or your symptoms may get worse.
You should avoid movements that cause severe pain, but you should not be immobile. Using cold compresses for the first few days, followed by warm compresses or heating pads, can help relieve your pain.
physical therapy
Stretches and special exercises can be used to stabilize your spine, improve range of motion, and open space for your nerve roots to pass.
Strengthening the muscles that support your spine can prevent further damage. Losing weight can also take pressure off your spine and nerve roots.
Orthosis
If you have a pinched nerve in your neck, your doctor may recommend that you wear a cervical collar or soft cervical collar. It will limit your movement and allow your neck muscles to rest.
It should be used for a short time, because if you use it for a long time, your neck muscles may weaken. Your doctor will provide you with details on when to use it and for how long.
In general, doctors do not advise wearing a back brace of any kind for pinched nerves in the lower back.
What is the perspective?
The vast majority of people with foraminal stenosis will find relief with home treatment. Surgery is rarely necessary.
Sometimes, even after your symptoms have resolved for weeks or years, they can return. Follow your doctor’s instructions regarding physical therapy and activity modifications, and your nerve pain will likely be a thing of the past.
Different types of medications can be used to relieve your pain:
- Non-Steroidal Anti-Inflammatory Drugs : Drugs such as aspirin, ibuprofen, and naproxen can reduce inflammation and relieve pain.
- Steroids : Oral corticosteroids, such as prednisone, can help relieve pain by reducing inflammation around the irritated nerve. Steroids can also be injected near the affected nerve to relieve inflammation and pain.
- Narcotics : If your pain is severe and other treatments have not worked, your doctor may prescribe narcotic pain relievers. They are usually used for a short time.
