So, what is neural foraminal stenosis? Let's break the name down and see what's what:
- Neural means 'related to the nerve cells and the nervous system.'
- Foramen (plural: foramina) is the area between the vertebrae – the opening through which nerve roots from the spinal cord travel and exit to other parts of the body.
- Stenosis is the narrowing of a duct or passage.
So, it is the compression of a spinal nerve as it leaves the spinal canal through the foramen. The nerves come from the spinal cord and go through the foramen to go to other parts of the body. When this opening isn’t big enough, the nerve does not have enough room and is compressed. Neural foraminal stenosis can occur in either the lumbar spine (lower back) or the cervical spine (neck).
What Causes Neural Foraminal Stenosis?
Neural Foraminal Stenosis is commonly caused by disc degeneration. As we age, the discs in our spinal cord may become herniated or bulge (poke out) out and take up the space meant for the nerves. This results in the narrowing of the foramen. As the foraminal continues to narrow, the nerves are compressed. This can cause pain, tingling, numbness and weakness in the muscles of the affected area.
Other causes of neural foraminal stenosis can be osteophytes (bone spurs) or rheumatoid arthritis (inflammation of the joints and surrounding areas). It may also be hereditary or be caused by environmental influences.
Sighting the symptoms
There are three types of neural foraminal stenosis. If the middle back is affected, it’s called the thoracic foraminal stenosis. If it’s the upper back, then it’s called cervical foraminal stenosis. And if the lower back’s nerves are trapped, it’s called lumbar foraminal stenosis.
Cervical stenosis affects the neck, shoulders, and/or the arms. Thoracic stenosis affects the mid back, and lumber stenosis affects the lower back, buttocks and/or legs.
Recurrent lower back pains that radiate to the buttock and lower leg occur if the sciatic nerve in the lower back is affected. There can also be numbness, tingling and weakness. The symptoms worsen with exertion and at times even walking may be difficult.
Diagnosis of Neural Foraminal Stenosis
Neural Foraminal Stenosis is difficult to diagnose since the symptoms are slow and gradual. With age the pain and symptoms may increase but as they aren’t continual, the condition remains difficult to diagnose. The best way to diagnose neural foraminal stenosis is through X-rays and MRI scans. But sometimes even with those the condition may go unnoticed.
Treatments for Neural Foraminal Stenosis
Depending on the severity of the symptoms, neural foraminal stenosis may be managed through non-surgical treatment. Options include: anti-inflammatory medications, cortisone injections, activity modification, physical therapy and exercise.
By improving your strength and flexibility and correcting your posture, physical therapy can help reduce your symptoms. The program will be designed to restore strength and flexibility in your neck or back.
Physical therapy for neural foraminal stenosis will usually show results within the first few weeks of the treatment. However a proper diagnosis should be made before starting a therapy program. An improper diagnosis could lead to an incorrect treatment plan. If the symptoms worsen, make sure to consult your doctor before continuing with it
Doctors usually recommend anti-inflammatory medicine and muscle relaxants as the first step in the treatment plan. Depending on the severity of the condition your doctor will prescribe either over the counter medicine or a stronger medication.
As time passes you will be able to assess what posture or movement triggers your pain. This awareness of the condition can help you avoid painful flare ups of symptoms.
Epidural steroid injections
These may be given for pain management depending on your condition. Epidural injections can help you feel more comfortable and manage pain better so you can make successful progress during physical therapy.
Resting is important. Especially when pain suddenly flares up, rest may help to relieve your pain. Do remember though to find balance between rest and exercise. Too much rest could do more damage and slow your neural foraminal stenosis treatment as muscles that are already weak worsen.
If non-surgical or conservative methods don’t prove effective, you can look into the possibility of surgical treatment. For patients whose daily lives are affected due to severe symptoms of neural foraminal stenosis, surgery is a good option. Before going into surgery however make sure that the diagnosis is accurate and you are medically fit to tolerate general anesthesia. And of course, that your surgeon is trusted and confident of the procedure as the best option for you.
Although neural foraminal stenosis is difficult to diagnose, most symptoms can be controlled through conservative measures. Just be sure to get a second opinion if you are suspicious of the condition and consult your doctor before beginning any treatment plan. You can’t fix the problem unless you know you have found it, so be sure to adhere to clinical advice.