When your back really hurts – potentially causing tingling in the arms and legs or even problems walking – you really want to know why. A substantial number of back pain patients are suffering from foraminal stenosis, a condition that’s most common in men and women over 50, according to Praveen Kadimcherla, MD, an orthopedic spine surgeon at Atlantic Spine Center.
What’s foraminal stenosis? Simply put, it occurs when spinal nerve roots – which run through tiny openings called foramina at every level of the spinal column – become compressed. This narrowing, called stenosis, can cause pain, tingling, numbness, and/or weakness in the arms or legs, whichever extremity is located closest to the compression.
Foraminal stenosis can be a highly uncomfortable condition to endure, explains Dr. Kadimcherla, who is fellowship-trained in orthopedic and spine neurosurgery.
“Patients get frustrated by the pain and discomfort they experience just being in certain positions or doing certain activities,” he says. “They may not know until they visit a spine specialist just what’s wrong.”
What causes foraminal stenosis?
Educating patients is the first step in dealing with foraminal stenosis, Dr. Kadimcherla notes. And their top question often is, what causes the condition?
In addition to aging, he says, foraminal stenosis can be caused by these problems:
- Bulging or herniated discs: When circular, spongy spinal discs protrude from the spinal column, they can pinch nerve roots in the foraminal openings.
- Bone spurs: Irregular bony growths known as bone spurs can develop on the foramina, pushing on nerve roots.
- Degenerative disc disease: When spinal discs break down – a condition also associated with aging – they can narrow foraminal openings.
- Spondylolisthesis: Bony vertebrae in the spine can slip over each other, triggering significant narrowing of the foramina.
“One of the reasons why it’s so important to consult with a spine specialist when you’re experiencing lingering, nagging back pain, numbness or weakness is because so many potential conditions may be combining to create a big problem,” Dr. Kadimcherla says. “All of the causes of foraminal stenosis can lead to significant suffering on their own, as well as contribute to a condition that can severely impact your quality of life.”
What can be done to treat it?
After answering what foraminal stenosis is and who tends to develop it, Dr. Kadimcherla usually tackles patients’ most pressing question: What can be done to treat it?
“Some patients are desperate to be rid of their nagging pain – though it often comes and goes – and just want to be able to move normally again,” he explains. “But if foraminal stenosis is diagnosed early, conservative treatment is usually effective.”
First up is getting an accurate diagnosis, which typically involves imaging tests such as x-rays, MRI scans or CT scans, all of which provide a different look at hard and soft tissues in the back.
Non-surgical treatments, many of which can be done at home, include NSAIDs (non-steroidal anti-inflammatory medications), which lessen inflammation in the region; activity modifications; in-office epidural cortisone injections; and physical therapy and prescribed exercises.
When is surgery necessary?
Occasionally, however, these conservative approaches simply don’t work. That’s when Dr. Kadimcherla and his colleagues at Atlantic Spine may consider a minimally invasive procedure called an endoscopic foraminotomy to alleviate foraminal stenosis.
“Once a patient complains about the inability to walk for significant periods of time without sitting to relieve pain, they’re usually at a point where they would probably benefit from surgical intervention,” he explains.
During an endoscopic foraminotomy, surgeons insert a small metal tube into a tiny incision in the patient’s back, using other tools through this tube to remove the debris – such as bone spurs, scar tissue or ligament overgrowth – causing the foraminal stenosis.
“Most patients can quickly go home and get back to their old life,” Dr. Kadimcherla says. “We do whatever it takes to allow people to be free of back pain.”