Foraminal stenosis is a painful condition caused by a narrowing of a foraminal canal, one of the passages through which nerves branch off the spinal cord. 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 of Foraminal Stenosis
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.
Treatment of Foraminal Stenosis
Effective treatment of foraminal stenosis can usually be achieved through nonsurgical techniques, including anti-inflammatory and analgesic medications, corticosteroid shots, physical therapy exercises, or through the use of a brace to immobilize the affected region of the spine. Electrothermal therapy may also be administered. Most patients benefit from a combination of these approaches, but those whose condition does not respond may require a surgical procedure.
Two operations, both minimally invasive, are possible options. The more common one, called a foraminotomy, involves a surgical incision in the back of the neck and small hole cut into the vertebra. With the use of an arthroscope, the surgeon removes bone or disc tissue that is impinging on the foraminal canal. The other procedure is a foraminectomy, an operation differing from the foraminotomy only in that a more significant amount of tissue is removed.