Foraminal Stenosis SymptomsSymptoms of cervical foraminal stenosis can include the following. If you have pain in the neck that radiates to the shoulder (usually the back of the shoulder), arm, forearm or hand, it may be coming from a nerve being compressed in the neck. Often this compression is occurring in the foraminal canal, which is a small bony tunnel between the spinal canal and the place where the nerve runs free out to the shoulder, arm, and hand. This area of narrowing or compression is referred to as stenosis, or cervical foraminal stenosis.
Foraminal Stenosis CausesOne contributor to severe cervical spinal stenosis is degenerative facet disease where the facet joint forms the back (posterior) wall of the foraminal canal.
Anything that causes enlargement of the facet joint will naturally intrude into the foraminal canal and thus compete for space with the nerve root passing through this tunnel on its way out to the shoulder, arm, or hand.
A degenerative facet may give rise to neck pain in two ways, one is the pain that might come from the degenerative facet by itself and two, is the pain that may arise from the increased pressure, that an enlarged facet, will exert on the exiting nerve passing through the foraminal canal. The pain from a degenerative facet is usually felt in the back of the neck, usually on one side or the other, as opposed to feeling the pain directly in the middle of the neck.
Facet Joint DegenerationDegeneration of the facet joint is characterized by loss of cartilage from the (articular) joint surface. Loss of the cartilage results in degenerative changes that include hypertrophy that means overgrowth or enlargement. These enlargements are sometimes referred to as osteophytes or spurs, and it is the presence of these spurs that can push against a nerve that would normally be passing through a smooth tunnel (foraminal canal) without pressure points.
If we have a degenerated facet joint that is inflamed, it can give rise to two types of pain. One pain is local from joint inflammation and irritation of soft tissues giving rise to local pain in the back of the neck called facet syndrome. The other pain from a degenerated facet is caused by its enlargement and compression of a nerve that is on the way to the shoulder, arm, forearm, or hand. These two pains (neck or extremity) may exist independently or together and each has a different endoscopic surgery solution, so as usual, the diagnosis is key.
What do we do about it?The diagnosis for facet syndrome is to place some anesthetic inside the facet joint and see if the pain goes away. The diagnosis for nerve root compression is a selective nerve root block that places some anesthetic near a nerve root to see if the pain in the shoulder, arm, forearm, or hand goes away.
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