Foraminal Stenosis
Dr. Jonathan Hall
Dr. Hall is a Board Certified Neurosurgeon that specializes in treating patients that suffer from neck pain or back pain. He is able to perform minimally invasive spine surgery and the most complex procedures.
What is Foraminal Stenosis?
The narrowing of the spaces between the bones in the spine, a condition known as foraminal stenosis, affects innumerable adults in the United States. This common degenerative spine condition affects the foramen, small openings in the spine where the spinal nerve roots run. Through the foramen, these nerve roots can access other parts of the human body, including muscles and organs. Technically, foraminal stenosis is spinal stenosis that affects the foramen, and when those small spaces tighten, it can squeeze the nerves, potentially resulting in a pinched nerve. Following a pinched nerve, the onset of radiculopathy is inevitable, so patients can expect one or more of the usual symptoms of degenerative spine conditions — pain, weakness, numbness, and long days filled with discomfort.
What Parts of the Spine Are Affected?
Patients can develop foraminal stenosis in the cervical, thoracic, and lumbar regions of the spinal cord. Symptoms vary by region, and patients may experience pinched nerves in multiple locations if their condition stems from a traumatic injury or they have advanced degenerative spine conditions.
Starting from the bottom of the spine, lumbar stenosis is the most common form of foraminal stenosis and is caused by narrowing of the foramen located in the lower back. Varying degrees of sciatica is the most common symptom. Moving upwards, thoracic stenosis affects the upper back. A pinched nerve in this region, while rare, can be quite frustrating to deal with. Significant pain and numbness envelop the torso from back to front, resulting in persistent discomfort. Finally, cervical stenosis targets the neck. Once a pinched nerve forms, a painful burning sensation can be felt in the neck, shoulders, and arms. “Pins and needles” is an apt description of the sensation of cervical stenosis. A feeling of weakness in the hands or arms may also be indicative of cervical stenosis.
What Are the Causes?
Foraminal stenosis is most often caused by the natural aging process. Wear and tear happens, it’s unavoidable. All of the trips you’ve taken, the mountains you’ve hiked, and the stairs you’ve climbed have slowly chipped away at your spine. Over time, this can lead to a litany of degenerative spine conditions — foraminal stenosis is one such condition. Other causes of foraminal stenosis include:
- Osteoarthritis
- Injury
- Herniated Disc
- Spondylolisthesis
- Bone Spurs
- Cysts
- Tumors
- Paget’s Disease
- Genetic Conditions
If you are experiencing pain in your arms or legs, inexplicable numbness that leaves you feeling paralyzed, sudden weakness, or a slowing of reflexes, consult your medical provider about the possibility of foraminal stenosis. Starting with a physical exam and an examination of your medical history, your medical provider will administer an imaging scan to accurately diagnose your condition. For instance, using an x-ray your medical provider can examine the alignment of the bones in your spine and check for signs of narrowed foramen. An MRI scan can also be used to check for issues with the intervertebral disks, which could be an indicator of foraminal stenosis.
What Is the Grading System?
The extent of the narrowing of the foramen may be graded to help the patient better understand the nature of their particular condition. Generally, this system is utilized in conjunction with MRI imaging results. A grade of “zero” is assigned to patients who exhibit no signs of foraminal stenosis. Mild stenosis with no signs of damage to the nerve roots is assigned a grade of “one.” Grade “two” foraminal stenosis still doesn’t show signs of physical changes to the nerve root, but it does exhibit further narrowing of the foramen. A grade of “three” indicates severe foraminal stenosis. That means the nerve roots are virtually on the brink of collapse. These patients experience the most severe symptoms.
What Are the Treatment Options?
Depending on how advanced a patient’s condition, their treatment options will vary significantly. Typically, foraminal stenosis and pinched nerves are first treated with conservative methods — activity modification, physical therapy, orthotics, and medication. Activity modification is basically a form of self-care — listening to the body, responding intelligently to pain, and getting lots of rest. However, patients don’t want to completely cease all activity, as this could actually advance certain symptoms.
Physical therapy is a combination of stretches and exercises that are designed to improve flexibility and range of motion, increase strength, and mitigate further damage. Physical therapy is also an important factor in the recovery process following surgery. Orthotics is a short-term treatment option involving a neck brace or cervical collar that can be used to provide relief for cervical stenosis; however, it’s hardly a permanent solution. Of course, medications are always an option for individuals with manageable symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs), oral corticosteroids, steroid injections, and narcotics may be effective at easing pain caused by foraminal stenosis.
Many patients will find that conservative treatments simply don’t provide the level of relief they are looking for. For these patients, the first step to recovery is a consultation with an experienced orthopedic surgeon. A spine surgeon can perform a number of procedures to help patients suffering from foraminal stenosis. These options depend on the location and severity of foraminal stenosis, as well as the cause.
For example, with foraminal stenosis caused by a herniated disk will need to have the disk removed or repaired. This procedure, a discectomy, can be performed using minimally invasive surgical techniques in an outpatient setting. Another popular option is a foraminotomy, a procedure used to enlarge the damaged foramen thereby alleviating compression on the nerve roots. This procedure may also be used to clear away bone spurs and obstructive tissue, too.
Most people are able to find relief for their symptoms using either conservative or interventional treatments; however, if you require surgery, the important thing is to facilitate an open dialogue with your spine surgeon to communicate any of your concerns. Together, you and your orthopedic surgeon can overcome foraminal stenosis.
Contact Florida Surgery Consultants
If you believe you have symptoms of a Foraminal Stenosis, contact Florida Surgery Consultants. We are a group of spine surgeons based out of Tampa, Florida. We can perform minimally invasive spine procedures for Foraminal Stenosis with fast recovery times. At Florida Surgery Consultants, we have some of the top rated spine surgeons in Florida. Listed below is the Spine Surgeons in Florida that perform surgeries for Foraminal Stenosis: