Foraminal Stenosis

Foraminal stenosis is a common condition that occurs when the space in the foraminal canal around the nerves narrows. The foraminal canal is the transitional bony canal between the large spinal canal and the free nerve root passing out to the shoulder, arms and hands or buttock, thighs and legs. This narrowing puts pressure on the spinal cord and/or the spinal nerve roots, often leading to pain, tingling, numbness and muscle weakness. The condition usually begins gradually and progresses over time. Depending on where the narrowing takes place, you may feel these symptoms in the lower back, buttocks, legs and feet, shoulder, arms and hands.

Who Gets Foraminal Stenosis?

Foraminal stenosis affects both men and women and is most common in older adults (50+); typically, the normal “wear-and-tear” effects of aging and arthritis of the spine cause it. (Degenerative changes of the spine are seen in up to 95% of people by the age of 50!) However, it may occur in younger people who are born with a small foraminal canal or those who have a herniated disc that pushes into the foraminal canal and competes with space for the nerve.

Types of Foraminal Stenosis & Symptoms

The most common forms of foraminal stenosis are cervical (the neck) and lumbar (the lower back). Thoracic foraminal stenosis, which affects the mid-back, is much less common. Many people show evidence of foraminal stenosis on MRI scans but have no signs or symptoms. Symptoms generally develop slowly over time (again, most common with patients of age 50+), and they may come and go. Unfortunately, these symptoms can eventually become chronic and quite debilitating. Symptoms vary, depending on the type and severity of foraminal stenosis:

  • Numbness, tingling sensations, or cramping in the limbs or extremities.
  • Difficulty standing and balancing.
  • Back pain, upper or lower.
  • Pain that travels through the body.
  • Sciatica (pain and muscle weakness that moves from the buttocks down to the feet).
  • Weakened bowel or bladder.
  • Muscle weakness.

Lumbar Foraminal Stenosis

Lumbar foraminal stenosis occurs in the lower back.  It may occur with or without central spinal stenosis.

Lumbar foraminal stenosis symptoms may include:

  • Lower back pain
  • Tingling, weakness, numbness or pain that radiates from your lower back into the buttocks and legs (sciatica)
    • Weakness, stiffness, numbness, cramping or pain in your legs, thighs or feet that makes it hard to walk (claudication)

More serious symptoms include:

  • Progressive leg, knee or ankle weakness

You’re typically comfortable at rest but symptoms flare up or get worse when you:

  • Stretch or extend your back
  • Stand straight for prolonged periods
  • Lean backwards

The pain gets better, sometimes almost immediately, when you:

  • Flex your spine forward, i.e. when you walk uphill
  • Lean over something (like a grocery cart)
  • Sit or lie down


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Cervical Foraminal Stenosis

Cervical Foraminal Stenosis occurs in the neck. Like lumbar foraminal stenosis, it’s frequently caused by age-related degeneration but may also be congenital or caused by disc herniation.

Cervical stenosis symptoms may include:

  • Neck pain and headaches
  • Weakness, numbness, tingling and/or stiffness in your neck, shoulders, arms, hands, or legs
  • Burning pain that shoots from your shoulder down your arm

More serious symptoms include:

  • Loss of ability to pinch or grasp
  • Loss of “position” sense (the ability to “know” where your arms and legs are when your eyes are closed)

Initial Treatments

Upon diagnosis of foraminal stenosis, the most common initial treatment will be directed toward controlling the swelling of tissue through NSAIDS (nonsteroidal anti-inflammatory drugs followed by a recommendation of physical therapy. Therapy can usually begin at home with a series of exercises targeting the affected area of your spine. Stretching usually responds well enough to offer alleviation of mild pain related to foraminal narrowing when done in conjunction with anti-inflammatory medication and the application of heat or ice therapy as necessary. Your physician can inform you as to whether your particular case would respond better to heat therapy or cold therapy. These treatments are a baseline of defense and can only reduce rather than eliminate symptoms.

Surgical Treatments

Foraminal Stenosis surgery may involve on of these procedures:

Cervical Foraminotomy

Cervical foraminotomy is a minimally invasive procedure for treating foraminal stenosis which involves removing a tiny piece of bone or tissue from the cervical spine that causing the compression of the nerve. When removing the cause of nerve compression, the fissure that the nerve needs to travel through between the vertebrae is enlarged, thus reducing symptoms associated with a pinched nerve. Cervical foraminotomy is considered minimally invasive surgery because it requires an incision of less than one-inch through the back of the neck. A tube is inserted through this incision for the removal of a small portion of the vertebra called the lamina. Highly specialized medical equipment is then used to access the compressed area for the removal of the bone or tissue.

Laminotomy

In some cases, spinal conditions cause the lamina to compress the nerves, resulting in the very common symptom described as a shooting pain through the extremities. Narrowing of the spinal canal—known as spinal stenosis—is the usual cause of this pain, but this minimally invasive procedure can also treat foraminal stenosis. This procedure, although similar to cervical foraminotomy, uses equipment to specifically remove the portion of the lamina causing the pain.

Microdiscectomy

Microdiscectomy, a non-invasive treatment, performed only as an outpatient procedure. In many cases, patients can expect to treatment and discharged within hours, although the possibility of overnight hospital stay under certain circumstances. A microdiscectomy requires a small incision allowing for the removal of any matter stemming from the disc which is pressing upon the spinal cord or nerve root.