Each level of the spine has bony, hollow archways on either side of each vertebra, referred to as foramina. Two nerve roots run through these openings. If one of these passageways for spinal nerve roots narrows, it’s a condition called spinal foraminal stenosis, also referred to as foraminal narrowing. If the space needed for nerve roots becomes significantly limited, nerves passing through may become compressed, or “pinched.” While lumbar (lower back) foraminal stenosis is more common, any level of the spine could be affected. Here’s what you need to know about foraminal narrowing.
The main cause of foraminal stenosis is shrinkage of the space needed for nerve roots, which is primarily caused by changes to the spine linked to the natural aging process. For some individuals, foraminal narrowing is sometimes hastened or caused by a disc that becomes herniated. Causes and contributing factors may also include:
• Acute trauma (e.g. a slip-and-fall accident or a hard impact to the spine) • Slipped vertebrae (spondylolisthesis) • Development of bone spurs (osteophytes) near spinal joints • Spinal changes caused by general wear and tear, or conditions such as arthritis • Cysts or tumors • Enlarged ligaments around the spine
It’s possible for passageways on both sides of a vertebra to be affected, which is referred to as bilateral foraminal stenosis. If this occurs, symptoms will be felt on both sides of the body. However, it’s more common for foraminal stenosis to affect one side of a foramen. In this case, the resulting discomfort would be relegated to one side of the body. Symptoms that may be associated with any type of foraminal narrowing include:
• Muscle weakness • Local pain in or around the affected area • Numbness or tingling in nearby extremities • “Pins-and-needles” sensations • Feelings of extreme heat
Treatment will depend on what’s causing the narrowing and the severity of the symptoms. With patients experiencing mild-to-moderate symptoms from foraminal stenosis linked to natural age-related changes in the spine, the main goal is usually to control symptoms as much as possible, which typically involves:
• Various physical therapy techniques • Patient-specific exercise routines • Pain or anti-inflammatory medications
If another condition is contributing to the foraminal narrowing, the underlying condition will need to be treated. For instance, if a herniated disc is making the narrowing worse, a minimally invasive procedure may be recommended to remove all or part of the disc. Even after a nerve root is no longer compressed, it may take a few months for the nerve to naturally heal itself. Barring issues related to acute trauma or nerve compression resulting in serious or debilitating symptoms, Santa Monica spine surgeons typically advise patients to try conservative treatments for 4-6 weeks before considering surgery.
Because the symptoms associated with foraminal narrowing can be similar to other sources of nerve compression, it’s important to get an accurate diagnosis as soon as symptoms become noticeable and disruptive to your daily life. Spinal foraminal stenosis isn’t entirely preventable. Although nerves are less likely to be compressed if you pay attention to your posture and take steps to keep the rest of your spine and its supporting soft tissues flexible, such as getting regular exercise and watching your diet habits.
To find out if they need a foraminotomy, Santa Monica patients can call The Spine Institute at 310-828-7757. Dr. Hyun Bae and his team of expert surgeons are here to help.