What is foraminal stenosis?
If you suffer from this you probably already know your diagnosis because of the symptoms you have had for a significant period of time or else you have recently noticed a more sudden increase in the symptoms common to this problem like arm or leg pain, lower back and gluteal (buttock) pain, or weakness and/or numbness is the arms and legs. These symptoms are due to bone spurs that form due to arthritis and thickened ligament and sometimes due to a disk herniation that adds to the increased compression of the nerve.
Patients that I have spoken with describe pain and discomfort that usually gets worse with standing and/or walking. Those patients start to notice that they tend to walk with a forward flexed posture because of the pain. They also find that they can walk a bit farther and alleviate the pain by bending forward while leaning on a shopping cart or by sitting down.
Patients with cervical (neck) stenosis notice that they can make their painful symptoms worse by positioning their neck and then relieve the pain by changing their neck position. The change in position and relief or worsening of symptoms is due the increase or decrease in compression of the nerve due to the stenosis.
I have found that most patients with these symptoms modify their life around what they are now able to tolerate. Meaning that they will start to walk shorter distances, use a motorized chair at a grocery store, limit going for a walk and generally start the process of becoming deconditioned and less able to tolerate exercise.
Foraminal Stenosis Treatments
Most patients start the treatment process by trying physical therapy and/or chiropractic care. Other options my patients have tried include Tai Chi and acupuncture.
The next step is often trying an epidural steroid injection. These can be done to directly target the area of stenosis. The effect is that the pain is usually improved for a period of time and then returns. The second injection doesn’t usually last as long as the first but is generally reasonable to perform.
When conservative measures fail or the stenosis is severe, or weakness and/or a progressive neurologic deficit is present then surgery is a great option to obtain relief.
Surgery usually involves a simple decompression called a hemilaminectomy. This involves removing a portion of the lamina to access the spinal canal and decompress the nerves that course along the facet joint where the bone spurs develop.
I have developed a technique that allows me to decompress the foraminal, lateral, central and paracentral stenosis on both sides of the canal from a unilateral one sided approach. This makes the recovery process easier for the patient because surgery is only done on one side of the spine but I am able to decompress both sides of the spinal canal.
Many surgeons perform surgery on both sides which unfortunately requires placing a retractor or tube style retractor through the multifidus muscles. Endoscopic spine surgery procedures have also been developed to remove the bone spurs. The beauty of this procedure is that it is commonly done through an incision less than one centimeter or slightly more than 3/8ths of an inch. The reason that I try to consider patients for an endoscopic approach to treat their problem is that is a muscle sparing “ultra” minimally invasive approach.