Your spine is made up of 33 vertebrae. Each one has openings to let nerves that branch off the spinal cord pass through to other parts of the body. When these openings, called neural foramen, narrow or get blocked, they can press on your nerves. This is called neural foraminal stenosis.
Types of Neural Foraminal Stenosis
Neural foraminal stenosis can happen anywhere along your spine. It's a type of spinal stenosis. Your spinal cord is a bundle of nerves that runs down the center of your spine. Nerves branch off of your spinal cord and connect to your arms, legs, and other body parts.
Cervical foraminal stenosis. This occurs in your cervical vertebrae, which are the spinal bones in your neck. Your neck is one of the most mobile parts of your spine and has to support your head, so it's a common place for foraminal narrowing to occur.
Thoracic foraminal stenosis. This is the least likely type of foraminal stenosis. Your thoracic spine is located in your upper back area. Thoracic foraminal stenosis can affect your shoulders and ribcage.
Lumbar foraminal stenosis. This is another common type of foraminal stenosis. The lumbar spine is located in your lower back. This is another very mobile area of your spine. It also has to hold up a lot of weight.
What Causes Neural Foraminal Stenosis?
Most causes of neural foraminal stenosis are degenerative, which means they happen over time as you age. It can also be caused by injuries. Some causes of foraminal stenosis include:
- Osteoarthritis, which can cause bone spurs to grow into the foramen
- Paget's disease, which also causes bone overgrowth
- Herniated disks, which can leak fluid that presses on your nerves
- Thickened ligaments, which can bulge into your foramen
- Tumors, though these are a less common cause
- Spinal injuries, which can cause dislocations or fractures
What Are the Symptoms of Neural Foraminal Stenosis?
Not everyone has symptoms of foraminal stenosis. Symptoms usually develop slowly over time, and they may come and go. It's most common in people over 50. Your symptoms will vary based on where the neural foraminal stenosis is located.
Cervical foraminal stenosis. Symptoms can include:
- Neck pain
- Balance problems
- Loss of bowel or bladder control
- Trouble using your hands
- Numbness or tingling in the hand, arm, foot, or leg
- Weakness in the hand, arm, leg, or foot
Thoracic foraminal stenosis. Symptoms can include:
- Problems with balance
- Numbness or tingling at or below the level of the abdomen
- Weakness or pain at or below the level of the abdomen
Lumbar foraminal stenosis. Symptoms can include:
- Sciatica, or pain that begins in your buttock and extends down the leg, possibly into the foot
- Weakness in the leg or foot
- Pain in the lower back that may come and go
- Numbness or tingling in the buttock, leg, or foot
- Loss of bowel or bladder control
- Pain that worsens when you stand or walk for long periods
- Pain that gets better when you lean forward, bend forward, or sit
How Is Neural Foraminal Stenosis Diagnosed?
If you think you have foraminal stenosis, talk to your doctor. After looking at your medical history, they'll look for limitations in your movement, ask about pain and numbness, and check your reflexes.
If your doctor thinks you have it, there are several procedures used for a formal diagnosis:
- X-rays show your vertebrae to help identify or rule out growths, injuries, and abnormalities.
- Magnetic resonance imaging (MRI) shows damage or disease that affects the cartilage and cushions between your disks.
- Computerized tomography (CT) scans give outlines of all the structures that surround your spinal canal, showing any impacts on your nerves.
- A myelogram is a procedure where your doctor uses a dye to show the movement of fluid between individual disks in your spine. Once they inject dye, they use a CT or MRI to see pressure points affecting your nerves.
- Bone scans identify fractures, growths, infections, and arthritis that impact your spinal column.
How Is Neural Foraminal Stenosis Treated?
Treatment for your foraminal stenosis will depend on the amount of nerve involvement and the severity of your symptoms. Your doctor will likely start with conservative treatment. Here is a brief look at some treatment options.
Medicines. This may include prescription or over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), prescription pain medicines, muscle relaxers, and steroids.
Correcting your posture. If your spine is not correctly aligned, it can cause stress on your lower back and neck.
Modifying your activities. Changing your home and work environment to reduce bending, twisting, and stretching can help your symptoms. You may need to learn proper lifting techniques as well.
Physical therapy. A therapist can help you learn exercises to improve your flexibility, strength, and circulation. This can help to reduce your pain and inflammation.
Braces. You may need to wear a brace for support.
Surgery. If your condition is causing severe pain or impacting your quality of life, your doctor may suggest surgery on the spine. The surgery, called a foraminotomy, may be more or less invasive depending on the degree of damage to your spine.
A neurosurgeon works with specialized nurses to perform a foraminotomy, which usually takes several hours. Here’s what you can expect during the surgery:
- You’ll lie on your stomach.
- Anesthesia puts you under so you don’t feel pain or discomfort during the procedure.
- Nurses monitor vital signs like your heart rate and blood pressure.
- Your surgeon makes a small incision beside the vertebrae on the side of your body affected by symptoms.
- X-rays and a microscope help guide the procedure.
- Your surgeon uses special tools to move muscles and ligaments blocking the opening, so they have a clear view of the vertebrae.
- Any blockage is removed, or bulging discs are repaired.
- Your doctor may need to remove a portion of your vertebrae to allow more room for your nerves.
- Your muscles and ligaments move back into place and the incision is closed with stitches.
After foraminal stenosis surgery, you usually resume a normal diet and activity. You may need to rest for a few days following the procedure and allow the surgical site to heal. Depending on the reason for your surgery, your doctor may recommend physical therapy.
Home Treatment Options
There are some things you can do at home to help your foraminal stenosis as well. Here are a few suggestions.
Pain relievers. Try using over-the-counter pain relievers such as NSAIDs to help relieve pain and inflammation.
Use ice or heat. You may be able to improve your symptoms with heat or ice.
Use assistive devices. A walker or a cane can help you avoid falls. They may also help relieve your pain by letting you bend forward while you walk.
Exercise. Talk to your doctor or physical therapist about what exercises you can do to improve your balance and strengthen your muscles.
Maintain a healthy weight. If you are overweight, losing weight can help take some of the stress off of your spine.
