What is 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.
- Extremity pain, upper or lower.
- Pain that travels through the body in a specific dermatome
- Sciatica (pain and muscle weakness that moves from the buttocks down to the feet).
- 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
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)
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. Transforaminal epidural steroids may help this as well. These treatments are a baseline of defense and can only reduce rather than eliminate symptoms.
Foraminal Stenosis surgery may involve on of these procedures:
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 causes compression of a nerve. When removing the cause of nerve compression, the canal 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 ½ inch through the back of the neck and avoids a fusion. A tube is inserted through this incision for the removal of a small portion of the vertebra called the facet. Highly specialized medical equipment is then used to access the compressed area for the removal of the bone or tissue. Watch a video about it here.