The spine is made up of a long system of bone, ligaments, and vertebrae. Between each of the thirty-three vertebrae, there is a soft spinal disc that acts as a shock absorber and together, they support much of the weight of the upper body and protect the spinal cord. This is vitally important, as the spinal cord is what connects the body’s nerves to the brain. Over time, the heavy workload done by the spine can lead to deterioration. When such an important part of the body begins to fail, the parts connected to it can quickly follow its lead. One such way this can happen is called Foraminal Stenosis.
“Foraminal” relates to an opening in the bone, and “Stenosis” refers to when a passage in the body narrows abnormally. Therefore, foraminal stenosis is the narrowing of the foraminal canal –or, more specifically, the narrowing of the openings in the spine that the nerves pass through on their way to the rest of
the body. This can lead to a pinched nerve, which causes pain and numbness if not treated quickly.
Depending on where in the spine the problem is, the symptoms can occur in different parts of the body. Stenosis in the cervical spine will transfer to problems in the neck, arms, or hands. Stenosis in the lumbar spine will create problems in the lower back, legs, and feet. All symptoms will usually start out small and gradually worsen over time. They include:
Numbness, tingling sensations, or cramping in the limbs or extremities.
Difficulty walking (limping or foot drop).
Back pain, upper or lower.
Non-continuous but recurring pain that stems from an action.
Pain that travels through the body.
Sciatica (pain and muscle weakness that moves from the buttocks down to the feet).
Weakened bowel or bladder
Most commonly, the cause of foraminal stenosis is a direct result of aging. As the body gets older, the spine deteriorates over time and causes stenosis or causes other problems that can lead to it. Some people are also genetically disposed to the condition from birth. Other causes include:
Swollen facet joints
Paget’s disease (where the bones grow too large and become brittle)
Spondylolisthesis (dislocated vertebrae).
A history of improper lifting techniques.
Sudden spinal injuries, like a fall, vehicle accident, or damage from contact sports.
Lack of exercise
Treatments for Foraminal Stenosis
Confirmation and diagnosis are usually given through X-rays, an MRI, or a CT myelogram. From there, treatment will be decided based on the severity of the stenosis and where it is located on the spine. A common overall treatment is to be prescribed some form of medication. Anti-inflammatory drugs can reduce problems caused by swelling or arthritis. Muscle relaxants and anti-seizure drugs can reduce spasms resulting from pinched nerves, and antidepressants and anesthetics can help ease the general pain. Localized pain injections can contribute to pinpoint and reduce pain as well. Sometimes herbal remedies are also prescribed to reduce or exterminate symptoms. After medication, one can try physical therapy. Starting a schedule of exercise and chiropractic appointments can gradually lessen symptoms and improve overall well-being. Strengthening muscles, bettering flexibility, and becoming more used to physical activity can decrease the amount of stress put on the spine. Additionally, regular massages can help correct any abnormalities in spinal composition. Using a cane or walker can ease the pressure put on the spine as well.
Since many treatments are small and are more geared towards alleviating the symptoms of foraminal stenosis instead of the cause, they may not work well or for very long. In cases like this, surgical procedures may be needed. They can be either traditional or minimally invasive surgery, depending on the severity of the stenosis. These surgeries are commonly referred to as spinal decompression surgeries and involve cutting into the back, moving aside the muscle, and working on the bone inside. A laminotomy involves removing only a small portion of ligaments and lamina (the flat part of the vertebral arch). With this method, the vertebra and spine are still firmly supported, which makes further instability much less probable. In a laminectomy, the entire lamina is removed, along with part of the facet joints and any enlarged ligaments that may be affecting the nerves. Another procedure involves making an incision one side of the laminae and pulling it open. This is known as a Laminoplasty. This allows for more space and expands the spinal canal, so the spinal cord and nerves have more room. A foraminotomy is sometimes included in these surgeries. in this procedure, bone is removed around the foraminal canals. It is usually only used when the discs between each vertebra have degenerated and caused the foramen to shrink in size and pinch a nerve. Rarely, spinal fusion may also be done during the process. Spinal fusion involves using bone grafts, metal rods, and screws to connect two vertebrae into one bone. This helps reduce pain and prevent repeat stenosis from occurring.
Get Ahead of It
If the condition is realized and diagnosed early enough, neither treatment nor surgeries may be needed. Lifestyle changes, such as ending damaging habits, exercising more, correcting posture, and other precautions can slow down or stop foraminal stenosis from starting before it begins.
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!)