Spinal Foraminal Stenosis

What is Foraminal Stenosis?

foraminal stenosisStenosis describes an abnormal narrowing of a passage or opening in the body and the foramen refers to an opening or hole (usually a bone) which allow blood vessels and nerve roots to pass through it. Spinal foraminal stenosis is the narrowing of the foramen within the spinal column.

Each of the 33 spinal vertebrae have a principal opening for the spinal cord, in addition to this there are foramen (small openings) in between the vertebrae –  these allow smaller nerves to exit the spinal column and innervate other areas of the body. The foramen consists of an encasement of the vertebrae below and above, which enlarges when bending forward and backwards.

In healthy spinal structures, nerves usually have adequate space to travel through the foramen, however in some cases these bony passageways may become blocked, this can result in nerve compression, causing a range of painful symptoms.

Foraminal Stenosis is typically unilateral, occurring on only one side and affecting one single nerve root, bilateral foraminal stenosis is rare. The condition can present at any point of the spinal column, however it is much more likely in the cervical and lumbar regions.

Causes

Degenerative spinal conditions are the most likely cause of foraminal stenosis. These may include the following:

Osteophytes

Also known as bone spurs, these bony outgrowths can occur on the edges of normal bone and are usually a result of age related wear and tear processes. Depending on their location, osteophytes can obstruct the narrow foraminal passageway and cause nerve compression or irritation.

Osteoarthritis

A form of arthritis in the spinal region, the wear and tear process causes the breakdown of the protective cartilage of the facet joints which link the vertebrae together causing swelling and pain –  in some cases provoking the formation of osteophytes, produced by the body in response to the damage.

Degenerative Disc Disease

The cervical discs serve to separate the vertebrae as well as absorbing shocks from everyday movement – as we age our discs begin to shrink, losing height and elasticity, leaving them more prone to herniation and bulging. Material from a herniated or bulging disc can encroach on nearby structures including nerve roots exiting the spinal column.

Spondylolisthesis

This describes a condition where one of the spinal vertebrae slips out of place now, it can occur at any point along the spinal column but is more common in the lower back. The out of place vertebrae can cause nerve compression.

Other possible symptoms include:

  • Injury/trauma
  • Cancerous tumours
  • Smoking
  • Obesity
  • Genetic predisposition

Symptoms

Foraminal Stenosis may be present but unnoticeable unless there is nerve compression involved.

Typical symptoms of nerve compression may include the following:

  • Localised pain
  • Referred pain
  • Numbness
  • Tingling sensations
  • Weakness
  • Burning sensations
  • General discomfort and inability to participate in day to day activities

Symptoms may vary depending on the location of the nerve compression, severe nerve compression can result in muscle weakness as the nerves and muscles are starved of nutrients – although permanent damage is rare.

Cervical Foraminal Stenosis

The cervical spine allows movement of the head and flexibility, making it susceptible to wear and tear related conditions.  Symptoms of nerve compression in the cervical region may include radiculopathy –  burning pains or tingling symptoms into the arms, shoulders neck and hands as well as numbness which can radiate as far as the arms and hands.

Lumbar Foraminal Stenosis

The lumbar vertebrae bear most of the weight of the upper body, connect the upper and lower body, as well as providing flexibility and movement. Lumbar foraminal stenosis often presents similar symptoms to those of sciatica, pain may radiate as far as the buttocks or leg. Pins and needles, weakness and burning sensations may be felt, reaching all the way down to the feet in some cases.

Thoracic Foraminal Stenosis

Obstruction or narrowing in the thoracic spine is the least common location of foraminal stenosis – this is mainly due to the stability of the thoracic region, in comparison to its cervical and lumbar counterparts, making this region less likely to suffer from degenerative spinal conditions.

Injury is perhaps the most frequent cause of foraminal stenosis in the thoracic spine, other causes may include degenerative conditions or be a result of structural abnormalities such as scoliosis or hyperkyphosis.

Diagnosis

A physical examination with a detailed medical history is usually followed by one or more of the following testing procedures to confirm the diagnosis.

MRI Scan – Useful for providing cross sectional views of the spine and surrounding soft tissues.

CT Scan – Combines X-Rays taken from various angles to produce detailed cross-sectional images of internal structures and bones

Myelogram – Involves the introduction of an injection of contrast dye into the spinal canal and nerve roots followed by an X-Ray or CT Scan to detect any abnormalities. Myelography may be used in addition to an MRI, or if the patient is unable to undertake an MRI Scan for any other reason.

Treatment

Conservative Methods

Non-surgical treatments will be offered initially for symptoms of foraminal stenosis, this may be a combination of medication to relieve pain and inflammation, in cases of extreme pain and discomfort stronger prescription based medication may be administered

Physiotherapy techniques and exercises can be targeted to reduce the amount of strain on the spine, this may be combined with corticosteroid injections for pain and inflammation relief.

Surgery

In more severe cases, where all other conservative methods have failed, surgery may be considered. There are several types of surgery available, minimally invasive procedures are often favoured over conventional open surgery for a number of reasons – there is less post operative discomfort, shortened recovery time and reduced internal scarring.

The Pain Management Clinic

Pain Management consultants specialise in chronic pain related conditions and the treatment of these often very complex conditions, working with a multi-disciplinary team of other pain management specialists including physiotherapists, surgeons, psychologists. Patients are provided with a comprehensive individualised treatment plan, taking into consideration the patient’s physical and psychological wellbeing.

Nerve Pain

nerve pain

Back Pain

back pain

Treatments

pain treatment