Vertebral bones are such that they stack on top of each other and the spinal cord passes through it. The space through which the nerves emerge is called a foramen. Nerves pass though the foramen from your spinal cord out to the rest of your body. When the foramen closes, the nerve roots passing through them can be pinched.
Foraminal stenosis is the narrowing of these spaces caused by enlargement of surrounding structures in the spine. Foraminal stenosis and pinched nerves are common. In fact, nearly half of all middle-aged and older people have some kind of spinal stenosis and pinched nerves.
Symptoms of Foraminal Stenosis
Symptoms of pinched nerves due to foraminal stenosis vary depending on which part of your spine is affected.
Pinched nerves in your neck due to cervical stenosis can cause a sharp or burning pain that starts in the neck and travels down your shoulder and arm. Your arm and hand may feel weak and numb with pins and needles.
Pinched nerve roots in the upper portion of your back due to thoracic stenosis can cause pain and numbness in the front of your body. This is the least common area to be affected by foraminal stenosis.
Lumbar stenosis (lower back) can be felt as pain, tingling, numbness, and weakness in the buttock, leg, and sometimes the foot. Sciatica is a term you may have heard for this type of pain.
The pain may worsen with certain activities, like bending, twisting, reaching, coughing, or sneezing.
Causes of Foraminal Stenosis
As we grow older, the onset of arthritis and wear and tear of the spine due to daily activities can lead to changes that may cause narrowing of foramen. In some cases, foraminal stenosis may also be caused by traumatic injury.
One possible cause of foraminal stenosis is a herniated disk. The cushioning disks between your spinal bones can become damaged and bulge. The bulging disk can encroach on the foramen and nerve root.
On occasion, bone growths in and around your foramen can also pinch the nerves running through. Bone spurs form due to injury or degenerative conditions like osteoarthritis due to long term inflammation.
Sometimes, foraminal spaces may be reduced in size due enlargement of ligaments around the spine and impinge on emerging nerves.
Foraminal stenosis can occur in people with cysts or tumours in the surrounding area, which may grow into foraminal space.
Diagnosis of Foraminal Stenosis
Foraminal stenosis is diagnosed based on medical history, physical examination and diagnostic imaging scans.
Physical examination: During a physical examination, the limitations on movement, loss of reflexes, pain and other symptoms which may occur due to the movement of the spine. Often, imaging studies may be a necessity to come to a specific diagnosis.
Diagnostic imaging: Radiological tests such as X-rays, CT scans and MRIs may be ordered. Electromyography and nerve conduction studies may be recommended to evaluate nerve function. Bone scans can help detect fractures, infections, arthritis, and tumors.
A proper diagnosis is required to treat this condition optimally and can help determine the necessity of surgical intervention.
Treatment of Foraminal Stenosis
Depending on the cause and severity of your foraminal stenosis and pinched nerves, several treatments are available to ease your discomfort.
In many cases, pinched nerves will get better with no treatment other than stretching, activity modification, and pain-relieving medicines. Doctors may recommend you to go for physical therapy to stretch and stabilise your spine and strengthen supporting muscles.
For some patients, oral steroids, may reduce inflammation around the irritated nerve. Steroids can also be injected around the affected nerve to relieve inflammation and pain.
When nonsurgical treatments are unable to help your symptoms, surgery may be considered. The type of surgery will depend on the condition and cause.
A minimally invasive endoscopic procedure called foraminotomy may be another option. It enlarges the area that the nerve passes through by removing obstructions, like bone spurs, from the foramen.
