What is Foraminal Stenosis?
Written by Neil Badlani, M.D., Chief Medical Officer, North American Spine

Foraminal Stenosis is a relatively common condition that brings about back pain when the openings that are located between the bones of your spine tighten or narrow. The spine is lengthy column of numerous bones that is situated in the middle of your back and provides a large amount of support to your upper body. The openings within the spine are referred to as foramen. Within these foramen are a variety of spinal nerve roots that connect to the rest of your body directly from your brain. These spinal nerves must be kept in good condition if you want your body to move and react as it’s supposed to. When the foramen tighten or narrow, the nerves inside of them can become pinched, which brings about foraminal stenosis and the myriad of symptoms that you can experience when suffering from this condition.

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More About Foraminal Stenosis

lumbar foraminotomyOne of the more unique aspects of foraminal stenosis is that the pain doesn’t always occur within the spine or the area around your spine. While back pain is common with this condition, the area of your body that the pain is most acutely felt depends on which nerve has been pinched. The pain will spread to whichever area of your body that the nerve directly serves. For instance, the pain can radiate out to the arms or legs. While this condition might sound as though it’s rare, the pinching of nerves in the foramen of the spine is common and can occur for any number of reasons. It’s estimated that close to 50 percent of adults who are middle-aged and older have experienced foraminal stenosis at some point in their lives.

 

The problem with determining whether or not you’re suffering from foraminal stenosis is that this condition doesn’t always come with symptoms. It’s also possible that you might experience symptoms of foraminal stenosis only for them to dissipate in a matter of days even if you haven’t obtained treatment. This condition is not a preventable one. However, there are ways in which you can lessen your risk of developing a pinched nerve in the spine, which include exercising more often and keeping your weight at a healthy level. It’s also important that you have good posture no matter what you’re doing. While foraminal stenosis can be a painful condition, it’s highly treatable and can go away without any form of medical treatment.

What Are the Symptoms?

The symptoms of foraminal stenosis depend on which portion of the spine the condition is affecting. The three basic types of foraminal stenosis include lumbar stenosis, cervical stenosis, and thoracic stenosis.

  • Lumbar Stenosis: Occurs within the foramen that are located in the lower portion of your back. When the nerve roots towards the bottom of your spine become pinched, you can experience such symptoms as weakness, pain, tingling, and a general numbness. These symptoms can spread throughout your leg, buttocks, and possibly even your feet. Lumbar stenosis is by far the most common form of foraminal stenosis.
  • Cervical Stenosis: Occurs along the foramen in your neck, which is where the uppermost portion of the spine is located. The pain that you will experience when the nerves in these foramen become pinched will likely be a sharp or even burning pain that’s situated primarily around your neck but can travel into the shoulders and the upper portions of your arm. When this condition is at its most severe, your hand and arm can feel numb and weak.
  • Thoracic Stenosis: This form of the condition affects the foramen that are located around your upper back. When the nerve roots in this area become pinched, numbness and pain will occur in the upper back, both of which can spread to the front portion of your body. While thoracic stenosis can be particularly painful, it’s the least common of the three types of foraminal stenosis.

No matter which of the three types of foraminal stenosis you’re suffering from, the pain can worsen significantly when you perform strenuous activities. Make sure that you avoid twisting, bending, or reaching constantly when you’re suffering from foraminal stenosis. The pain can also worsen when you cough or sneeze, which is a clear sign that you’re affected by this condition.

How is Foraminal Stenosis Diagnosed?

When you’re suffering from foraminal stenosis in any area of the spine, you will invariably experience a certain amount of numbness and pain. If this pain subsists for more than a few days, it’s highly recommended that you see a doctor so that you can have the issue diagnosed. While the nerves in your back may have been pinched, it’s also possible that the pain could be caused from some other condition. Knowing what condition you’re going through is the key towards being provided with a treatment plan that will get rid of the pain you’re experiencing. Foraminal Stenosis can be diagnosed by doing the following:

  • Physical Examination: A physical exam by your doctor will check your level of pain in the affected area, your reflexes, the general movement of your body and your overall muscle strength.
  • Symptom Assessment: The doctor needs to know as much as possible about the symptoms the patient is experiencing. This involves answering a series of questions to give a sense of whether pain is dull or sharp, as well as where and when it’s likely to occur.
  • Diagnostic Imaging: The main types of tests that can be administered to you include CT scans, MRI scans, X-rays, bone scans, and studies on nerve conduction. Each test and scan has a different focus that can assist the doctor in identifying the condition that you’re going through. For instance, a bone scan is able to detect a wide range of conditions that extend from fractures and infections to tumors. On the other hand, x-rays are able to identify how well or otherwise the bones in your spine are aligned. If the space between the bones is too narrow, an x-ray can determine that foraminal stenosis has occurred.

What are the Causes of Foraminal Stenosis?

low back pain

The tightening or narrowing of the space between the bones within your spine can be caused from a litany of issues. Potential causes include:

  • Age: You will have a higher risk of developing this condition as you become older. Over time, such conditions as arthritis as well as the wear and tear of everyday life will automatically cause some changes to your spine. These changes can result in the foramen becoming narrowed and foraminal stenosis developing.
  • Physical Injury: Injury is the main cause for its existence in younger people. In the event that you experience a herniated disk, these disks can press directly on the foramen and cause the nerve foots within to become damaged. The formation of bone spurs in the spine that are caused by osteoarthritis or injury can also lead to foraminal stenosis.
  • Presence of a Tumor
  • Genetics: Conditions such as dwarfism
  • Ligament Enlargement: The enlargement of certain ligaments that are located around the spine
  • Spondylolisthesis

How is Foraminal Stenosis Treated?

Treatment and procedure options for Foraminal Stenosis range from conservative options like injections to more intensive procedures like spinal fusions.

Conservative Options

Conservative treatment options include nerve root blocks and steroid injections. These are designed to provide temporary relief (up to one year), and you may elect to have the procedure done multiple times. Other conservative strategies may include the placement of a spinal cord stimulator–or STIM–which is designed not to correct the underlying degeneration, but to lessen the pain the condition causes.

Decompression

Minimally invasive decompression surgery aims to relieve pressure on the nerves of the spine. This pressure is often caused by stenosis, bulging or herniated discs, and more. Relieving this pressure can be achieved by reducing or removing soft tissue (disc material or scar tissue) or bone (bone spurs, a section of the lamina or foramina) to decompress the affected nerve. When the compression is caused by soft tissue material, a surgical laser may be used to shrink the impinging material.

Fusion/Stabilization

Fusion surgeries are similar in goal–to remove damaged disc tissue and fuse the bones together–but differ in approach, including the use of specialized hardware to reinforce stability, and the location used to gain access to the spine. A related procedure is an artificial disc replacement, in which a damaged cervical disc is replaced with a synthetic disc, and the vertebrae are not fused.

How Much Does Treatment Cost?

Treatment cost depends on several factors, especially what insurance you have and how much of your deductible has been met. IN the last two years, 90% of our patients have paid less than $2000 out-of-pocket. Some have paid literally nothing, and other have paid much more than that. It depends. The good news is: our Patient Care Managers will handle as much as they can directly with your insurance company, and all your costs will be known up-front.

Important note: spine surgery often pays for itself within a year or two. Many people actually spend more money trying to live with the pain than they do getting the pain fixed. The following calculator is intended to give you a sense of what you spend on managing—rather than eradicating—your pain.

 

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This past year you have spent on your pain treatment:

Get surgery now. Getting surgery now is the smartest financial move. Over the last two years, the average North American Spine patient spent around $2,000 out-of-pocket for treatment. You’ve spent that much or more this year to manage your back pain than you could to fix it.

Get surgery soon. Over the last two years, the average North American Spine patient spent around $2,000 out-of-pocket for treatment. At your current rate, you will spend that much or more within the next two years. The sooner you get treatment, the sooner it will pay for itself.

Keep an eye on your spending. Currently, you are managing your pain efficiently from a financial perspective but over time, your expenses could add up. Surgery should be strongly considered if you start missing more work or spending more on treatment medication.

Great job! You are spending very little on your back pain. Keep it up!

Equipment Used to Diagnose and Treat Foraminal Stenosis

The main equipment used in the diagnosis of foraminal stenosis include x-ray machines and MRI machines, both of which scan for important information that can identify whether or not you’re suffering from this condition. During the physical examination, a reflex hammer is often used when testing your reflexes. Most treatment options don’t require the usage of any medical equipment. However, if a herniated disk is the cause and surgery is necessary, incisions will be made in your back or neck in order to remove the problematic disk. These incisions are made with the assistance of a fluoroscope, which is a type of x-ray machine. A very thin needle is then used to locate the affected disk. Additional equipment like surgical microscopes and surgical drills may be needed depending on the extent of the issue.

How Does Foraminal Stenosis Compare to Similar Conditions?

Foraminal stenosis is a very precise term that refers to the pinching of a nerve within the foramen of the spine. However, this term is oftentimes used interchangeably with spinal stenosis, which is a more general condition that foraminal stenosis falls under. If you picture spinal stenosis as an umbrella, the various types of stenosis that fall under that umbrella include central spinal stenosis, foraminal stenosis, and pseudo-claudication. Even though these terms can be used to describe slightly different conditions, they may all be used in place of each other by a doctor or surgeon.

In general, a spinal stenosis refers to any situation that causes the spinal column to become narrower. The main reason that foraminal stenosis is considered to be its own thing is that it mainly affects vertebral foramen, which differs from a spinal stenosis that can affect various kinds of foramen. The central stenosis condition is a type of spinal stenosis that causes the thecal sac in your lower back to become compressed, which can create a large amount of pressure on the nerves situated at the end of your spinal cord. Although these types of spinal stenosis can typically be used interchangeably, your doctor may be able to find a more targeted treatment approach when the diagnosis is more specific, which is why a spinal stenosis can sometimes be diagnosed as a central spinal stenosis or foraminal stenosis.

Analogy: A Tunnel with a Train Track

The nerves of your spine travel like trains on a track. Along their journey, they duck through many enclosed spaces in the vertebrae, like foramen. In order for them to function properly, they must pass through these enclosed spaces cleanly. Foraminal stenosis can collapse some of these spaces like a collapsed tunnel on a train track. If the train of your nerves can’t get through or are pinched by a space that has become too tight, you will feel pain.

Good Tunnel

Bad Tunnel

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