What Is Foraminal Stenosis? Causes, Symptoms, And Treatments
Back pain is, unfortunately, a very common condition. According to NIH, lower back pain alone afflicts at least 80% of adults at some point in their lives. Some back pain causes can even lead to symptoms in other parts of your body. There are many reasons why this happens, and one of them is foraminal stenosis. That’s quite a mouthful, but what does this condition really mean for you and your health? Read on to learn what foraminal stenosis is, what it feels like, how it’s diagnosed, and how you can treat it if you do have it.
Your spine is made up of 33 small bones called vertebrae. Between each vertebra is a small space, or foramen, that allows nerves to thread through your spine. In a healthy spine, the foramen are large enough to comfortably accommodate these nerves. But sometimes, for a variety of reasons, a foramen becomes compressed. The bones press closer together, potentially putting pressure on the nerves between them.
Foraminal stenosis is a type of spinal stenosis, which occurs when the spinal column narrows and puts pressure on the spinal cord. But there are differences between the two conditions. As already discussed, foraminal stenosis, also called neural foraminal stenosis, occurs when a foramen (rather than the spinal column) narrows. This can happen anywhere in your spine, from your lower neck all the way down to your lower back.
The location of the compression will determine where in your body you feel symptoms—assuming you feel any symptoms at all. Neural foraminal stenosis can be asymptomatic; you might not realize you have it unless and until a nerve gets caught in the narrowed foramen.
However, you may see this condition referred to by more specific names depending on whether the affected nerve is, such as your:
- Neck (cervical foraminal stenosis)
- Upper back (thoracic foraminal stenosis)
- Lower back (lumbar foraminal stenosis)
The most common of the three is lumbar foraminal stenosis.
In most cases, symptoms only manifest on the side of your body where the nerve is compressed. But in cases of bilateral foraminal stenosis, the nerve is pinched on both sides of the spine, so you will experience symptoms on both sides of your body.
There are many reasons why this condition develops. You might already have an idea of what the cause is in your case; for example, if you’ve been diagnosed with a bone condition, such as arthritis in your back, that could be the reason.
But regardless of whether you have a strong suspicion or no idea at all, it’s important that you go to a doctor for an examination and a formal diagnosis. We will discuss the diagnosis process and why it is so important later in this post.
Here are a few of the most common foraminal stenosis causes.
Arthritis is one of the main culprits behind foraminal stenosis. This condition can affect your vertebrae in numerous ways. It is best known for causing joints to become inflamed, but it can also weaken the bones, as is the case with osteoarthritis.
Weak bones are more likely to move out of place than strong ones. Also, sometimes arthritis leads to bone spurs. These are bony protrusions that grow over existing bone. When they develop in the spine, they may block the foramen.
A back or neck injury may also cause the foramen to tighten.
If you have suffered trauma to your back—for example, if you were in a car accident, or if you hurt yourself while playing a sport—you may be at increased risk for foraminal stenosis.
There are numerous conditions that can affect the bones in your spine and that, in turn, can lead to foraminal stenosis. Herniated discs (where the cushioning spinal disc between vertebrae slips out of place) and degenerative discs (where the vertebrae themselves move out of alignment) can both put pressure on spinal nerves. Spondylolisthesis occurs when a vertebra in your lower back shifts down onto the one beneath it.
As with foraminal stenosis itself, all of these conditions may be completely asymptomatic unless and until the vertebra or spinal disc starts to press on a nerve.
Some illnesses can increase your risk of foraminal stenosis. Various bone diseases—including Paget’s disease of bone, when your body produces bones that are weaker than they’re supposed to be—can lead to a narrowed foremen.
Tumors have also been known to cause this condition, but try not to worry too much about that. Only in very rare cases is foraminal stenosis caused by cancer.
Symptoms will vary depending on your condition’s severity and the location of the affected foramen. Your symptoms may ebb and flow, and they may never go away entirely.
Four of the most common foraminal stenosis symptoms are:
Other symptoms include muscle spasms and trouble with walking or maintaining your balance.
In cases of cervical foraminal stenosis, your symptoms will likely be focused in your upper body, particularly your arm and hand. You may feel pain, tingling, or numbness radiating down the affected limb.
Thoracic foraminal stenosis symptoms will manifest all the way around your upper torso. Symptoms may worsen during or immediately after performing certain activities.
The symptoms of lumbar foraminal stenosis often radiate from the lower back into the leg, foot or glute.
And finally, in cases of bilateral foraminal stenosis, whatever symptoms you have will manifest on both sides of your body.
The good news is that this condition is typically very manageable. Symptoms are usually controlled well with conservative therapies. We’ll discuss some of the most common treatment methods later on.
There are some rare cases where foraminal stenosis becomes serious enough to warrant a reevaluation of your treatment regimen. Your symptoms may get worse over time, necessitating more drastic treatments to keep symptoms in check.
Dealing with a worsening medical condition can be difficult and upsetting, and you should keep your doctor updated on how you’re feeling so that they can guide you towards better, more effective treatments. However, gradually worsening symptoms do not generally require an emergency trip to the doctor. By contrast, if your symptoms begin to rapidly get worse, seek medical help immediately.
Sometimes, lumbar stenosis leads to cauda equina syndrome. The symptoms of this serious condition include:
- Extreme pain
- Numbness and/or weakness in the lower extremities
- Sexual dysfunction
- Loss of bladder or bowel control
If you are experiencing these symptoms, get help immediately. Delaying treatment of cauda equina syndrome can result in permanent nerve damage, including paralysis.
Only a physician can formally diagnose you. If you suspect you have this condition, let your doctor know and explain what symptoms you have been experiencing.
Your doctor will review your medical history and run tests to determine if you do have foraminal stenosis. These tests may include one or more of the following:
- A magnetic resonance imaging (MRI) scan uses magnetic fields and radio waves to create a picture of your internal organs.
- An X-ray utilizes radiation to create a picture of your bones, enabling your doctor to see your spine without surgery.
- A computed tomography (CT) scan also utilizes X-rays, but a CT scanner will take many different X-ray images and combine them into a more detailed picture than a single X-ray could produce.
- A bone scan involves injecting a radioactive tracer into your bloodstream. This will make the resulting image clearer so any abnormalities are easier to spot.
- A myelogram is another kind of X-ray. Your doctor will inject a contrast agent into your back before taking the X-ray. As with the tracer used in the bone scan, the contrast agent will result in a better image.
- An electromyograph determines if there is damage to your nerves or muscles. Your doctor will first apply electrodes and then needles to the affected area to test how your muscles and nerves interact with each other.
Your doctor will decide which of these tests is right for you. The types of tests they run will depend on several factors, including your health, other medical conditions you have, and where in your body you are experiencing symptoms. Some of these tests will help your doctor directly diagnose foraminal stenosis, while others will eliminate other potential causes of your pain.
Even if you already feel completely sure that you have foraminal stenosis, it is important to let your doctor perform their own examination and tests. This way, they can rule out potentially life-threatening pain causes, including cancer.
Once you have an official diagnosis, you and your doctor can discuss which treatment options are right for you. Foraminal stenosis treatment options range from holistic methods you can do on your own at home to more interventional measures performed in a clinical setting. Always check with your doctor before starting any treatment regimen, as not all treatments are safe for all patients in all situations.
One critical treatment is exercise. Certain exercises can ease pain and strengthen the body, making it better able to cope with illness and injury. Medications, either over-the-counter or prescription, may help relieve pain as well. If these treatments are not enough to relieve your pain, you can also try heat/cold therapies and physical therapy.
In extreme cases, as a last resort, your doctor may recommend either injections or surgery to relieve foraminal stenosis pain. Injections deliver medication, such as corticosteroids, directly into the painful area. Your doctor may also suggest performing a temporary spinal nerve block. Spinal nerve blocks may treat chronic pain that doesn’t respond to other kinds of treatments. The temporary type usually involves a surgeon injecting an anesthetic directly into the affected area.
When it comes to surgery, your doctor may decide to perform either a permanent spinal nerve block or a foraminotomy. Unlike the temporary spinal nerve block, the permanent type involves surgically cutting off or damaging the affected nerve. A foraminotomy is when a surgeon physically enlarges the foramen to relieve the pressure on the nerve.
Again, both surgery and injections are not first-line treatments for foraminal stenosis pain. In the overwhelming majority of cases, you will find pain relief with at-home or conservative treatments.
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