Foraminal Stenosis

Spinal stenosis occurs when the spinal cord, usually in the neck (the cervical spine) or the spinal nerve roots in the lower back (the lumbar spine) are compressed. A specific type of spinal stenosis is called foraminal stenosis, named after the foramina, the passageways that branch away from the spinal canal and house the nerves that travel from the spine to other parts of the body. When a foramina becomes obstructed or narrowed the nerve running through it becomes compressed and causes pain in the areas that the nerve serves.

Dr. Girardi has extensive experience treating foraminal stenosis, which, unfortunately, often requires surgery to alleviate the chronic pain.

What is Foraminal Stenosis?

When one or more of the foramina, the canals/passageways where the nerves leave the spine, narrows, often because of the development of bone spurs or from osteoarthritis, this compresses the nerve. This leads to pain that usually radiates into the area served by the nerve. In the cervical spine, the pain can travel into the shoulders, arms, and hands. In the lumbar spine, this pain may radiate down into the legs, a condition also known as sciatica.

Unlike many back or neck issues, foraminal stenosis doesn’t usually respond to nonsurgical treatments because the nerve remains compressed in too small a space. The only way to relieve this compression is to open the space in the foramina with surgery.

Symptoms of Foraminal Stenosis

Foraminal stenosis typically occurs in the cervical and lumbar spine areas. Symptoms vary depending on which area of the spine is affected. Still, there are some general symptoms for foraminal stenosis. These usually affect one side of the body:

• Pain and discomfort that are localized or radiate to nearby extremities
• Muscle weakness
• Numbness
• Tingling or “pins-and-needles” sensations
• Unexplained symptoms in the neck, shoulders, arms, and hands (cervical spine) or the lower back, hips, buttocks, legs, and feet (lumbar spine)
• Sciatica

There is overlap in these symptoms with spinal stenosis, so it is not as if this is a totally isolated condition. Pain of foraminal stenosis develops slowly; this is not an “instant injury” type of pain. The pain is not continuous, but it is often triggered by an activity such as riding a bike.

Foraminal Stenosis Causes

This condition may be the result of a congenital defect, aging, osteoarthritis, rheumatoid arthritis, a thickened ligament, a herniated disc, a bone spur, or the enlargement of a vertebral joint. Most frequently, it is caused by disc degeneration.

As the foraminal canal becomes clogged, pressure is exerted on the nerves. This may result in pain, numbness, weakness, or tingling sensations throughout the arms and legs, depending on which area of the spine is affected. This pain, which radiates through the peripheral nerve to an extremity, is caused by nerve compression and is known as radicular pain. Often this pain presents only on one side of the back of neck, although it may also be bilateral. Without treatment, the pain usually worsens over time. With treatment, it may be greatly alleviated.

Diagnosis

Foraminal stenosis is diagnosed after a medical history is taken, a complete physical examination is performed, and one or more diagnostic imaging tests are administered. These tests may include X-rays and MRI, CT, or bone density scans. They are administered for two reasons: to rule out other conditions that may be responsible for the patient’s symptoms and to confirm the diagnosis of foraminal stenosis.

Foraminal Stenosis Treatment Options

Unlike many back and neck problems, foraminal stenosis usually doesn’t respond to nonsurgical treatment. This is because the compression as the nerve runs through the foramina cannot be addressed except with surgery. Still, Dr. Girardi seeks to exhaust conservative treatments before moving ahead with surgery.

Nonsurgical treatments include:

• Activity modification — Patients may be able to live with foraminal stenosis if they are willing to forego certain activities that tend to trigger pain.
• Physical therapy — Losing weight and strengthening muscles that can then reduce strain placed on the affected area of the spine can help.
• Medication — Foraminal stenosis usually involves inflammation of the surrounding tissues, in addition to the nerve. This can be addressed with anti-inflammatory medication.
• Steroid injections — Steroid injections aren’t as beneficial with foraminal stenosis as some other back conditions, but they can calm the inflamed nerve in some patients.

If these conservative treatments don’t alleviate the patient’s pain, Dr. Girardi usually performs either a foraminotomy or a foraminectomy. These surgeries can usually be performed using minimally invasive methods. Both of these procedures are used if the patient has had debilitating pain caused by foraminal stenosis for at least 3 to 6 months.

What is a Foraminotomy?

The goal of a foraminotomy is to surgically relieve the pressure on the nerve running through the foraminal passage. In the procedure, Dr. Girardi makes a small incision just beside the spine on the side where your symptoms are occurring. He will then push back the muscles around the spine to expose the foramina where the nerve is compressed. The blockage may be a bone spur or a bulging disc. The will remove whatever is causing the pressure, whether than means removing the herniating portion of the disc or grinding off bone spurs. He may also remove part of the vertebra, if necessary, to further relieve pressure. This is called a laminectomy.

What is a Foraminectomy?

The goal of a foraminectomy is the same — to alleviate pressure on the spinal nerve being compressed by foraminal stenosis. This procedure is a little more involved than a foraminotomy, as it removes more spinal irregularities. A foraminectomy almost always is combined with a laminectomy, where the lamina part of the vertebra is removed to give the nerve more room. A foraminectomy may also include a discectomy, where the entire disc is removed if it has herniated and is pushing on the nerve. The disc can be replaced with an artificial spacer or the two vertebrae involved may be fused together.