CONDITIONS EXPLAINEDForaminal Stenosis
CONDITIONS EXPLAINEDForaminal Stenosis
Foraminal stenosis is a condition in which small openings along the spine, called foramina, become tighter and compress the nerves passing through them. This compression impairs nerve function, and can lead to pain, weakness, and numbness, a condition known as radiculopathy. Untreated, these changes can become permanent. Fortunately, most cases are quite treatable, with a good prognosis for patients.
Stenosis can occur at any level of the spine including the cervical and thoracic vertebrae, but the lumbar region is most commonly affected. Cervical stenosis affects the neck, and may manifest with numbness, pain, and tingling of the upper limbs. Turning the head typically does not trigger the symptoms, but looking upwards or downwards may elicit them. Stenosis of the thoracic vertebra is the least common, but may present with associated symptoms that wrap around the trunk of the body. As aforementioned, the lumbar region is the most common, and will present with pain, numbness, and tingling in the buttocks and lower extremities. This condition is more commonly known by the name of sciatica.
Symptoms of foraminal stenosis can vary greatly between individuals, and may come and go with time. A large portion of middle aged and older adults will experience foraminal stenosis, as many as half in one study. Prevention is difficult, but keeping healthy with regular activity and normal body weight will reduce your chances of developing this condition. Injuries to the back can further complicate the delicate organization of back structures, and maintaining good posture or technique while sitting, lifting, or other activities that stress the back will help limit such injuries.
Advancing age is the most common predictor for stenotic vertebrae, but in other groups such as younger individuals, injury will more commonly precipitate issues of stenosis. Bulging vertebral discs are some of the most often seen factors in injury-related stenosis. Disc degeneration also regularly occurs with advancing age, and will manifest with the bulging nucleus of the vertebral disc cushioning each vertebral junction, compressing the spinal cord and its nerve roots.
Other less common etiologies include:
- Syringomyelia
- Various Bone Diseases
- Ligament enlargement around the spine
- Tumors and cysts
- Spondylolisthesis
- Bone Spurs
Foraminal stenosis is a condition in which small openings along the spine, called foramina, become tighter and compress the nerves passing through them. This compression impairs nerve function, and can lead to pain, weakness, and numbness, a condition known as radiculopathy. Untreated, these changes can become permanent. Fortunately, most cases are quite treatable, with a good prognosis for patients.
Stenosis can occur at any level of the spine including the cervical and thoracic vertebrae, but the lumbar region is most commonly affected. Cervical stenosis affects the neck, and may manifest with numbness, pain, and tingling of the upper limbs. Turning the head typically does not trigger the symptoms, but looking upwards or downwards may elicit them. Stenosis of the thoracic vertebra is the least common, but may present with associated symptoms that wrap around the trunk of the body. As aforementioned, the lumbar region is the most common, and will present with pain, numbness, and tingling in the buttocks and lower extremities. This condition is more commonly known by the name of sciatica.
Symptoms of foraminal stenosis can vary greatly between individuals, and may come and go with time. A large portion of middle aged and older adults will experience foraminal stenosis, as many as half in one study. Prevention is difficult, but keeping healthy with regular activity and normal body weight will reduce your chances of developing this condition. Injuries to the back can further complicate the delicate organization of back structures, and maintaining good posture or technique while sitting, lifting, or other activities that stress the back will help limit such injuries.
Advancing age is the most common predictor for stenotic vertebrae, but in other groups such as younger individuals, injury will more commonly precipitate issues of stenosis. Bulging vertebral discs are some of the most often seen factors in injury-related stenosis. Disc degeneration also regularly occurs with advancing age, and will manifest with the bulging nucleus of the vertebral disc cushioning each vertebral junction, compressing the spinal cord and its nerve roots.
Other less common etiologies include:
- Syringomyelia
- Various Bone Diseases
- Ligament enlargement around the spine
- Tumors and cysts
- Spondylolisthesis
- Bone Spurs
Experiencing Symptoms of Foraminal Stenosis?
Detection & Diagnosis
Detection starts with presenting to a physician for evaluation. A thorough physical exam can give a great deal of insight into the nature of back problems, but your doctor will typically order one or more diagnostic tests to help confirm their suspicions. These tests may include:
OUTCOMESRelated
Treatments & Procedures
Addressing foraminal stenosis is a multi-step process, and surgery is usually the last resort after less invasive measures have been taken. Not uncommonly, rest alone will be enough for the stenotic areas to resolve. Such measures may include:
Limiting painful motions, though not limiting motion entirely, is important to reduce aggravation of the affected site. Motion is important to keep blood flowing across the regenerating tissues that need it most, and too much limitation of movement can lead to maladaptive habits. Light and careful activity with the use of ice in the first few days followed by heat, such as with a heating pad is recommended. Electrical stimulation can also help, usually in the form of a TENS unit.
Specialized stretches and exercises can help stabilize the spinal column. Strengthening the spine can help compensate for vertebral instability. In addition, weight loss will reduce the pressure on the spine, and can alleviate compression of the nerve roots.
NSAIDs, Steroids, and Narcotics. NSAIDs such as aspirin, aleve, and ibuprofen can do a great deal to reduce pain and inflammation. In patients for whom this is inadequate, stronger narcotics may be prescribed. Steroids are an additional medication that can provide long term relief by reducing inflammation, and are typically injected at the site of stenosis.
Cervical stenosis may be treated with a short term neck brace to provide some measure of rest for the recovering structures, but long term use weakens local musculature and should be avoided. A back brace is not typically recommended for back problems, however.
If your condition proves resistant to other treatment options, your doctor may recommend surgical intervention. The exact treatment will vary depending on the exact cause of the stenotic foramen, but removal of a bulging disc or enlargement of the foramen itself are commonly performed. Surgery can lead to complications, however, and may result in more severe symptoms if the nerve compression is exacerbated.
Anterior Lumbar Interbody Fusion
Anterior Lumbar Interbody Fusion (ALIF) is a procedure performed from the anterior to fuse vertebrae into a single structure. This technique is usually favored when..
Artificial Disc Replacement
Artificial disc replacement is a procedure with the goal of removing a painful intervertebral disc and replacing it with a prosthetic one. Spinal fusion is much more commonly performed..
Decompression (Laminectomy)
Decompression Lumbar Laminectomy is the most common surgical procedure performed for the correction of stenosis in the back. The surgeon will remove or trim the bony lamina and a thick ligament..
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