Chronic back pain sufferers are certain of only one thing: that their back really hurts and keeps on hurting. But they may not know about a condition called “foraminal stenosis”: a foraminal narrowing in the openings between the vertebrae in the spine. The symptoms can include tingling in the arms and legs or even problems walking, according to Kaixuan Liu, MD, PhD, founder and medical director at Atlantic Spine Center.
What is foraminal stenosis?
The fact is, a substantial percentage of back pain patients are coping with spinal stenosis, which is most common in adults age 50 and older, Dr. Liu says. But what is it? Foraminal stenosis means spinal nerve roots, which weave through small openings known as foramina at all levels of the spinal column, are being compressed or pinched. This narrowing is called “stenosis” and can lead to pain, tingling, numbness, and/or weakness in the arms and legs, depending on which limb is closest to the compression.
Foraminal stenosis symptoms
“Certain positions or movements can cause a frustrating level of discomfort for patients with foraminal stenosis,” Dr. Liu explains. “Various other back conditions can lead to similar symptoms, so visiting a spine specialist can help pinpoint this diagnosis, which is really crucial if you’re experiencing lingering, nagging, back pain, numbness and/or weakness. Cervical stenosis symptoms can really hamper your ability to just enjoy your life.”
Diagnosing foraminal stenosis
If you’re diagnosed with foraminal stenosis, it’s important to understand that it’s not your fault and that you likely couldn’t have avoided it from developing in the first place, Dr. Liu notes. Aging is one of the top causes of foraminal stenosis, followed by other problems such as bulging or a herniated spinal disc, bone spurs, degenerative disc disease, which causes discs to break down, and spondylolisthesis, which is when bony spinal vertebrae slip over each other.
How do doctors diagnose foraminal stenosis? The patient’s clinical history and physical examination are critical. The pain associated with nerve symptoms such as burning, tingling, numbness, and weakness suggests a pinched nerve from foraminal stenosis. Additional tests such as an MRI, a nerve block study to determine where the pain is originating from, or nerve conduction testing/EMG may be important to determine which nerve is pinched, where the foraminal stenosis is, and how severe the nerve injury is.
“As with most medical conditions, getting an accurate diagnosis is key,” he says. “When we know that foraminal stenosis is the cause of a patient’s symptoms, it empowers both patient and doctor to tailor a treatment approach that improves symptoms and ideally restores them to pain-free living.”
Foraminal stenosis causes
There are several types of foraminal stenosis.
Cervical foraminal stenosis occurs in the cervical vertebrae in the neck.
Thoracic foraminal stenosis happens less often, but it usually affects the upper back, in particular shoulders and rib cage.
Lumbar foraminal stenosis occurs in the lower back, which holds a lot of weight.
Spinal stenosis causes are mostly degenerative but include conditions such as osteoarthritis, which causes bone spurs to grow into the foramen; herniated discs, with which fluid can leak and press on the nerves; tumors; some spinal injuries, that can cause dislocations or fractures.
As our cervical spine degenerates, whether due to age or other conditions, foraminal narrowing may occur as trapped debris compresses the nerves exiting through the foramen. Nerve impingement due to cervical canal stenosis can cause nerve death, which is a serious problem. The spinal cord consists of nerves and as nerves die, we experience loss of function, which may then affect our senses or sensations and motor ability.
Foraminal stenosis treatment
What can be done to treat cervical stenosis? If diagnosed early, conservative, non-surgical approaches usually work, Dr. Liu says. Some of these treatments often can be done at home and include:
- NSAIDs (nonsteroidal anti-inflammatory drugs) such as ibuprofen, naproxen or prescription versions, which decrease inflammation
- Activity changes
- Physical therapy and prescribed exercises
- Epidural cortisone injections, which are administered in a doctor’s office
Sometimes conservative measures don’t adequately lessen a patient’s pain or discomfort from canal stenosis, however. If that happens, Dr. Liu considers a minimally invasive surgery known as an endoscopic foraminotomy. During this procedure, surgeons insert a small metal instrument into a tiny incision in the patient’s back. Endoscopic tools that are used through this small tube remove debris such as bone spurs, scar tissue or ligament overgrowth that’s causing the foraminal stenosis symptoms.
“Surgery isn’t needed for the vast majority of foraminal stenosis patients, but those who can’t walk very far without sitting to relieve their pain typically are good candidates,” Dr. Liu says. “Whether conservative or surgical measures are needed, most with foraminal stenosis patients will be able to happily go back to their everyday lives.”
For a quick educational video and more info on Stenosis in the spine visit our What is Foraminal Stenosis page.