The spinal cord is the central communication highway of the body, connecting the brain to nerves that extend from head to toe. The foramina—openings in the spine—play a crucial role in this system by allowing nerves to branch out to the limbs. However, when these openings narrow, a condition known as foraminal stenosis occurs, leading to potential nerve compression and serious health concerns.
In this post, we’ll explore the causes, symptoms, and treatment options for foraminal stenosis, providing you with the knowledge to manage this condition effectively.
The Foramina: A Closer Look
The foramina are created by the pedicles of the vertebrae. Pedicles connect the front vertebral body to the bony portion that forms the back of the spine. More specifically, the posterior of the spine consists of the lamina, facet joints, and spinous processes.
The foraminal opening houses the spinal cord and allows nerve roots to exit from the spinal column through the sides of each vertebra.
When the spinal column loses shape and stability, it can constrict these openings. This may occur due to injury or disease. Moreover, this narrowing can apply pressure on the spinal cord or nerve roots, affecting the nerve’s ability to function. Compressed nerves may lead to several neurological symptoms—of which we will discuss in detail later.
So what specifically causes this narrowing? Foraminal stenosis can result from a variety of factors or conditions.
Common Causes of Foraminal Narrowing
- Degenerative facet disease: A condition that causes the facet joints at the back of the vertebrae to enlarge. As the facet joints lose cartilage, the joints may compensate by growing more bone. The growth of osteophytes, or bone spurs, means less room for each foramen.
- Herniated discs: In between each vertebra is a doughnut-shaped, rubbery structure that enables the spine to absorb shock. When the gel-like inner layer of the disc breaks free of the tough outer layer, the disc becomes herniated. Disc herniation takes up more “free” space in the spine. Moreover, the damaged disc can intrude into the foramina, causing stenosis.
- Degenerative disc disease: As we grow older, the discs between each vertebra tend to dry out and slowly lose their shape. Advanced degenerative disc disease may even cause the discs to collapse. Unfortunately, when a disc collapses, so do the walls of the foraminal canal.
- Spondylolisthesis: This condition occurs when a vertebra in the spinal column slips backward or forward out of place. Furthermore, the instability and structural changes in spondylolisthesis often reduce foraminal space.
- Spinal arthritis: Inflammation of the spinal joints can also change the structure of the spine. And, as you already know, this may also narrow the foramina.
Who Can Be Affected by Foraminal Stenosis?
Degenerative and structural changes to the spine play a big role in foraminal stenosis.
So you’re probably thinking: This can only happen to older people. After all, their spines have endured years of wear and tear.
But, that’s not always the case.
Younger people may also develop foraminal stenosis after an injury. A bad fall, car accident, or sports injury may damage discs or other spinal structures. Also, anyone regardless of their age may develop a spinal tumor. Changes in the spine, of any variety, can cause the foramina to narrow.
Your lifestyle can also affect the spine. Smoking, obesity, and occupations that require excess bending, lifting, or twisting can result in adverse structural changes to the spine.
How do you know if you have foraminal stenosis? Let’s take a look at the common symptoms.
Symptoms of Foraminal Stenosis
You can develop foraminal stenosis in different areas of the spine. The symptoms vary based on where this condition develops.
In general, any form of foraminal stenosis may exhibit the following symptoms:
- Burning pain that radiates to other areas of the body
- Pain that develops slowly and may come and go
- A tingling or “pins and needles” sensation
- Numbness to extremities
- Muscle weakness
- Worsening pain when coughing or sneezing
- Pain related to a specific activity
Symptoms by Spinal Section
- Lumbar Foraminal Stenosis: When foraminal stenosis occurs in the lower back, it affects your lower body. The symptoms can spread throughout your leg, buttocks, and even the feet. Lumbar stenosis is the most common form of foraminal stenosis.
- Cervical Foraminal Stenosis: This narrowing occurs in the neck area. As a result, the symptoms manifest in the upper body. Symptoms of cervical foraminal stenosis can be felt in the neck, shoulders, and upper arms. Severe cases can even lead to pain and numbness in the hand.
- Thoracic Foraminal Stenosis: The upper back area of the spine has more support and stability than the lower back and neck. Why? The rib cage and sternum provide additional support to this area of the spine. While rare, thoracic foraminal stenosis can affect the upper back and chest.
How can you be sure your symptoms are due to foraminal stenosis? After all, many spinal conditions share similar symptoms.
An orthopedic doctor will listen to your symptoms and perform the necessary tests to diagnose foraminal stenosis and rule out any other spinal conditions.
Diagnosing Foraminal Stenosis
Accurately diagnosing foraminal stenosis plays a vital role in treatment. Your doctor will start by reviewing your medical history and listening to your symptoms. During an initial examination your doctor will want to know:
- When did the pain or other symptoms start?
- What does the pain feel like?
- Where do you feel pain and symptoms most?
- What activities make the pain worse?
- Are there any positions that reduce pain and symptoms?
- What is your current activity level?
- Do you engage in sports or an occupation that may affect the health of the spine?
After gathering the necessary information, your doctor will conduct a physical exam. During this exam, your doctor will check your reflexes, muscle strength, and any pain associated with movements in the body.
Diagnostic tests will help your doctor rule out any other spinal conditions. These tests can include imaging techniques such as x-rays, MRIs, and CT scans.
Foraminal Stenosis Treatment
Once diagnosed, your doctor will likely suggest conservative treatments. The following, for example, can be easy fixes to assist with symptom management for foraminal stenosis:
- Resting the area: While this may not solve all of your problems, taking some time to rest can alleviate inflammation and pain.
- Medications: Both over-the-counter and prescription medications may also reduce pain and inflammation. Be sure to take the medications exactly as prescribed. Some pain medications can be habit-forming.
- Massage: A licensed massage therapist has an intimate understanding of conditions like foraminal stenosis. A massage can relax tight muscles and increase circulation, both of which are necessary for the healing process.
- Physical Therapy: A massage therapist can relax tight muscles. On the other hand, a physical therapist can strengthen these muscles, leading to even more long-term benefits. Additionally, a physical therapist can also prescribe exercise routines, suggest activity modifications, and teach you how to alter your personal habits to live pain-free.
- Therapeutic injections: Applying medications directly into the source of the pain can be even more effective in relieving pain and inflammation than taking a pill.
Unless you’re suffering from major neurological issues, you will probably start with the conservative treatments mentioned above. But, what if your condition is more severe?
Treating Severe Foraminal Stenosis: When Conservative Approaches Fail
You’ve tried conservative treatments. They just don’t seem to help.
So what’s next?
Surgery may be your next option. Sure, the thought of going “under the knife” can seem scary. But, there’s some good news. More and more neck and back surgeries are becoming minimally invasive. This means that tiny cameras and surgical tools enter your body through only a small incision. In fact, the incision may be as insignificant as only a couple inches.
Aside from less scarring, minimally invasive surgery boasts several other benefits. Before we go into those, however, let’s talk about the types of surgeries that may relieve severe foraminal stenosis.
Common Surgical Procedures for Foraminal Stenosis
- Foraminotomy: A minimally invasive procedure in which your surgeon removes a tiny piece of bone or soft tissue that is causing compression on a nerve. This enlarges the openings of the foramina. As a result, the nerve has more space and is no longer pinched.
- Laminotomy: Similar to a foraminotomy, this procedure removes part of the lamina (at the back of the spine) to free up space for the nerves.
- Microdiscectomy: Another minimally invasive treatment that removes part of the disc that is pressing on the nerve or blocking the foramen. This is generally needed when damaged or herniated discs are causing your pain.
- Discectomy and spinal fusion: If a disc is severely damaged, it may need to be removed. Once the disc is removed, a bone graft and other surgical tools are used to encourage the two vertebrae fuse together as one bone.
Thanks to modern technology, many of these surgeries are minimally invasive procedures. Compared to traditional open surgeries, these procedures offer several benefits including:
- Less blood loss and damage to surrounding tissue
- Less postoperative pain
- Quicker recovery times
- Smaller scars
- Less reliance on possibly addictive pain medications
- Shorter hospital stays—some procedures may even be performed in an outpatient clinic
Get Help Now with your Severe Foraminal Stenosis
Want to get help from a team of professionals who see you as a person and not just a medical chart? Spinal issues can be frustrating and difficult to manage. Who can you turn to when you have questions and concerns about your specific treatment?
New York City Spine Surgery, PLLC will closely evaluate your spinal condition. From there we create a treatment plan based on your lifestyle and individual needs. We will empower you with choices for both conservative and surgical treatments based on what you really need.
Call us at (855) 210-0899 so we can get started helping you return to the life you want to live!
