What Is Foraminal Stenosis?
It’s the restriction or narrowing of the openings within a spine known as foramen. It is through these openings that nerve roots pass to and from our spinal cords. It is also through this cavity that spinal nerves go through as they exit the backbone. The openings or apertures are prone to contracting when the spine degenerates, affecting intervertebral discs, vertebrae, and other spine tissues. Each level of the spine has a foramen on each side, and spinal nerves pass through each one at each level. Since these openings are small, anything that encroaches on them leads to pinching of nerves and foraminal stenosis.
Foraminal stenosis usually occurs as a form of degenerative disease and occurs slowly as the spinal column wears. Different conditions like bulging disc, herniated disc, swelling of soft tissues, bony growth, and arthritic changes of the spine could encroach on the foramen, causing the nerves in it to be compressed. When this happens, various symptoms like pain along the length of a compressed nerve, localized pain, muscle weakness, numbness, or even tingling may start being experienced.
Foraminal stenosis generally occurs alongside degenerative disease of the spine; however, it can also be a primary problem for some patients. Some of the most common causes of the problem include bone spurs, inflamed soft tissue, calcified ligaments, misaligned vertebrae, and herniated disc materials. The good thing though is that stenosis can be managed through conservative treatment that’s designed to ease pressure on a patient’s back, allowing the body to heal itself. Some of the treatment options available include physical therapy, rest, hot/cold compresses, the use of braces, corticosteroid injections, and pain medication. If these options fail, then surgical treatment is recommended.
Classification of Foraminal Stenosis
As we have already seen, foramen are openings on each side of a spine’s vertebrae that allow nerve roots from the spinal cord to pass. Bilateral narrowing is where both foramina are affected while unilateral narrowing affects only one foramen. The narrowing of areas surrounding nerve roots once they have exited from a foramen is known as far-lateral stenosis – a condition that may be brought about by the degeneration of the spine or by injury.
Foraminal narrowing is considered a problem when the restricted spaces lead to compression of nerves bringing about symptoms like numbness, weakness, tingling, or pain. While foraminal narrowing can occur at any level of the spine, the most commonly affected areas are the lumbar and cervical regions. Since the thoracic region offers stability, the spine around the area is protected against degeneration. However, that is not the case with the area around the neck and lower back since these areas experience constant stress brought about by movement and as they support the body’s weight.
Types of Foraminal Stenosis
Cervical Foraminal Narrowing
This type of foraminal narrowing happens around the area surrounding the cervical region and affects the upper portion of the back, shoulders, head, and upper extremities with pain growing gradually over time. In the early stages, victims may experience occasional discomfort that’s especially associated with particular activities like sitting behind a desk for long periods or riding a bicycle and is often mistaken for muscle strain in the areas around the upper back or neck. Cervical foraminal narrowing starts becoming a problem when nerve roots are compressed leading to debilitating pain, muscle weakness, numbness, and such. Restriction of foramen around the cervical region may lead to symptoms in the shoulders, upper back, neck, fingers, hands, and arms. Treatment options include corticosteroid injections, exercise, and the use of pain medication among other conservative treatment methods.
Thoracic Foraminal narrowing
Thoracic foraminal narrowing happens around the thoracic region and affects internal organs, shoulders, and rib cage. Its symptoms are quite similar to those of thoracic spinal stenosis with the only difference between the two being that in thoracic foraminal stenosis there’s a narrowing of the vertebral foramen. The narrowing of foramina in the thoracic region is usually brought about by age and may either be degenerative or congenital – with degeneration being the more common cause. As deterioration increases, the pain also increases with prolonged standing or during or after activities.
For people suffering from congenital thoracic foraminal narrowing, a small injury may aggravate the symptoms as the canals are already narrow, allowing for compression to happen more easily. Treatment options include physical therapy, the use of over-the-counter and anti-inflammatory medication, and cortisone injections (though there’s a limit as to the number of injections a patient can get over a given period of time).
Lumbar Foraminal Narrowing
Lumbar foraminal narrowing happens around the lumbar region and affects the buttocks, lower back, and lower extremities. The narrowing of foramina around the lumbar spine is a degenerative, gradual process that generally results in neuropathic symptoms such as sciatica and pain around the lower back.
Narrowing around this region may go unnoticed if passages do not narrow to the point where they constrict nerves causing symptoms. Treatment is often determined by the severity and source of the stenosis. The good thing though is that nonsurgical and conservative treatments generally offer sufficient pain relief. If traditional methods do not abate the pain around the lower back, then surgery is recommended.
Most of the conditions that lead to foraminal stenosis are age-related with degenerative disc disease and osteoarthritis being the more common reasons in older people. Foraminal narrowing symptoms may vary in severity and may affect the lower or upper body – depending on where the compressed nerve root is.
As with all health issues and problems, Foraminal stenosis has some related risk factors that could accelerate things. They include sedentary lifestyles, smoking, obesity, participation in high-impact sports, and occupations that require constant bending, standing, driving, sitting, twisting, and lifting.
Foraminal Stenosis Diagnosis Options
– X-rays
– Complete neurological examinations
– Bone scans
– Magnetic Resonance Imaging (MRI) scans
– Computerized Tomography (CT) scans
– Myelogram – where an opaque type of dye is injected into a patient’s spinal column followed by a CT or MRI scan
The good thing is that foraminal stenosis can be managed if detected in good time. As such, it is advisable that you consult with your doctor if you are experiencing some of the symptoms mentioned in this article.