Back & Neck Conditions
What is Foraminal Stenosis?
Neural Foraminal Stenosis refers to the narrowing of the intervertebral foramen, a small hole through which nerves exit our spinal canal and travel through our body. Neural is defined as having to do with nerve cells or relating to a nerve, and is often added to the condition’s name.
As foraminal narrowing begins to compress the nerves, various foraminal stenosis symptoms such as pain, numbness, pins and needles or a tingling sensation, and weakness may be felt. If the narrowing affects the nerves in your neck, you may feel symptoms in your shoulders, arms, and hands. If you have foraminal stenosis in your lower back, you will feel symptoms in the buttocks, legs, and feet.
Foraminal stenosis causes
As our 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 neural foraminal 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. There are several types of foraminal stenosis.
Cervical foraminal stenosis occurs in 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, that causes bone spurs to grow into the foramen; Paget’s disease that cause overgrowth; herniated discs, with which fluid can leak and press on the nerves; tumors; some spinal injuries, that can cause dislocations or fractures.
Foraminal stenosis symptoms
Foraminal stenosis symptoms develop over time in some patients, some might not even notice the onset of this condition. Because of the location of foraminal stenosis, pain can be located in the neck, a person can have balance issues, loss of bowel or bladder control, unpleasant sensations like tingling or numbness in ligaments, or weakness. These symptoms are typical for cervical stenosis.
Spinal stenosis symptoms are characterized by balance issues, numbness or tingling in or below the abdomen. You can also experience weakness or pain in or below the abdomen.
Lumbar stenosis symptoms include sciatica, which is pain in the lower part of the body, as well as weakness in legs or feet. You can feel pain in the lower back or numbness and tingling in legs, feet and buttocks. This pain is usually worse after standing or walking for a long time. In severe cases, cervical stenosis symptoms involve a loss of bowel or bladder control.
Foraminal stenosis diagnosis
To determine a correct treatment plan, your doctor will first have a diagnosis procedure. The first step is to discuss the symptoms and perform a physical exam. A doctor will ask you to bend or to show some parts of the body to check for numbness or loss of sensations. You can also show the doctor the moves that either help ease the pain, or increase it.
There are two types of inspection during a physical exam: a visual and a hands-on inspection. The first one is used to check the posture and the skin. The second one is used to determine tenderness or spasms. There are also a number of motion tests to check the mobility of the joints.
Also, there may be other tests performed. For example, a blood test or imaging tests. Imaging tests include X-rays that show if there are any bone spurs. If there are reasons to think that you have a pinched nerve, an MRI or a computed tomography can be performed, as well as electromyography or a nerve conduction study.
Foraminal stenosis treatment
Most cases of stenosis respond well to non-surgical treatment, although if your symptoms persist and the pain is interfering with your quality of life, we may recommend a foraminotomy procedure as a treatment option. In general, treatment depends on the severity of the symptoms. Usually, the first option is conservative treatment.
Medication might include prescription drugs like oral steroids or – for short periods – opioid analgesics, and muscle relaxers; over-the-counter remedies such as non-steroidal anti-inflammation drugs (NSAIDS) like naproxen and ibuprofen; and steroidal injections to control inflammation around the nerve.
Some activities, such as lying in bed for long periods, can worsen your pain, so try to avoid them. There are several at-home remedies to ease the pain. Among them is using heat or cold and applying it to the affected areas. Gentle stretching can also be helpful to ease the pain.
You can also join physical therapy. The goal of physical therapy is to strengthen the muscles of the spine, abdomen, buttocks, and hips; stretch tight muscles like the hamstrings; increase core strength; and improve aerobic conditioning with gentle exercises like walking, and water therapy. Some forms of massage therapy can be helpful to relax tight muscles and improve circulation.
In some cases, you might need to wear a brace to support muscles or have a surgery. Usually, surgery is recommended to widen the foramen in case of severe spinal stenosis when conservative treatment has failed. Preventing back issues is the best thing you can do to minimize the chance of developing back conditions and back pain.
Regular exercise - cardiovascular exercise and weightlifting - strengthen the supporting muscles of the back, pelvis, and thighs and activities like yoga and tai chi stretch the muscles and improve flexibility.
Good nutrition can also help your spine. Foods that are high in calcium and vitamin D, such as dairy foods and leafy green vegetables, can help prevent the bones in your spine from becoming thin and brittle. Drinking enough water is another key part of nutrition. As liquid is an essential part of back tissues and many back issues originate from tissue dehydration, mind your water intake.
Use proper lifting techniques. Do not bend at the waist. Bend your knees while keeping your back straight, and use your strong leg muscles to help you support the load.
Practice good posture when walking, sitting, standing, and sleeping. For example, stand up straight with your shoulders back, abdomen in, and the small of your back flat. Sit with your feet flat on the floor or elevated. Sleep on a firm mattress and sleep on your side, not your stomach.
Try to invest in proper equipment. Using a high-quality chair, a good mattress and a pillow allow you to maintain good posture while sitting and get a good sleep to prevent back issues.