About Foraminal Stenosis
When narrowing of the cervical disc space occurs, it is known as foraminal stenosis. Enlargement of a spinal canal joint causes the narrowing. The condition is often diagnosed after years of symptoms. The extended period of symptoms indicates foraminal stenosis. It commonly occurs in the neck, but it can also occur in the spine. Imaging technology, such as MRI or a CT scan, confirms the diagnosis.1 Foraminal stenosis is a particular form of spinal stenosis. Commonly, people who are middle-aged have foraminal stenosis. Older patients often have some form of spinal stenosis or pinched nerve. It cannot be entirely prevented, but there are ways to reduce the risk of foraminal stenosis. Exercise, practicing good posture, and injury prevention are some ways that patients can reduce the risk of developing different types of stenosis.2
What Is Stenosis?
Spinal stenosis is the abnormal narrowing of a channel in the body. Stenosis can be congenital or degenerative. In most cases, degeneration causes stenosis. Some people do not feel the symptoms for a while. The narrowing can occur at different points on the spine, but the symptoms are often similar.3 For most people, aging causes the spine to degenerate rather than traumatic injury. Genetics can leave some patients more likely to develop spinal stenosis. Over time, the spinal canal changes in shape and size, and it will often place pressure on the spinal cord or nerves of the spinal cord. With age, ligaments thicken, bony spurs develop, discs bulge or herniate, and other factors come into play that affect the spine. The pressure causes the symptoms of stenosis. The arms, lower back, and legs can experience symptoms. Some cases are worse than others.4
Symptoms of Foraminal Stenosis
Foraminal stenosis causes many symptoms, and it shares symptoms with other physical conditions. Diagnosis is important so that the proper treatment is used. Patients could experience numbness, tingling, or cramping in their limbs or extremities. They might also have trouble standing and balancing. There may be symptomatic pain in the upper or lower back, and pain can also travel through the body. Sciatica, which is pain and muscle weakness from the buttocks down to the feet, could also be present. Muscle weakness, as well as weakness in the bowl or bladder, could also occur. Progressive leg, knee, or ankle weakness are more serious symptoms. Different types of foraminal stenosis cause variation in symptoms. Certain actions, such as stretching or extending the back, standing straight for extended periods of time, and leaning backwards could worsen symptoms. Patients should seek medical attention as soon as symptoms appear.5
Types of Foraminal Stenosis
There are different types of foraminal stenosis, including cervical foraminal stenosis, lumbar foraminal stenosis, bilateral foraminal stenosis, thoracic stenosis, and neural foraminal stenosis. The pinched nerve symptoms vary depending on the type of foraminal stenosis. Cervical stenosis develops in the narrowed neck and can cause pain and weakness in the shoulder, arm, and hand. Thoracic stenosis develops in the upper back, and it causes pain that wraps around to the front of the body. Lumbar stenosis develops in the lower back, and it is felt as pain, tingling, and numbness from the buttock down to the foot. The symptoms from lumbar stenosis are also known as sciatica. Activities such as bending, twisting, reaching, coughing, and sneezing can worsen stenosis in different ways. Some forms of stenosis are more common than others, and thoracic stenosis is least commonly affected by foraminal stenosis.6
Foraminal Stenosis Treatment
There are treatment options, depending on the severity and cause of the stenosis. Patients who have radiating pain, numbness, and weakness may rest for a few days, but they should not rest for too long. Movement that causes sharp pain should be avoided, but patients should not be motionless. Cold packs can be used for the first days, and then warm packs can ease pain. Physical therapy and exercises are used to stabilize the spine, improve range of motion, and strengthen the muscles. Orthotics can help ease misalignment and improper posture caused by the feet when standing and walking. Medications, such as Advil and Aleve can provide pain relief and ease inflammation. Doctors might prescribe steroids or narcotics for a short time. When conservative treatments have not provided relief, the doctor could consider surgery. Sometimes, only a minimally invasive procedure is necessary.7
Neural Foraminal Stenosis
Neural foraminal stenosis is a form of spinal stenosis that could cause no symptoms, or it could lead to paralysis. Generally, this form of stenosis affects only one side of the body. When stenosis affects both sides of the body, it is bilateral neural foraminal stenosis. The symptoms are similar to other forms of stenosis, including pain, weakness, and sciatica. In milder cases, the treatment options are also similar. Doctors might prescribe anti-seizure medications or corticosteroid injections. In severe cases, minimally invasive treatments like laminotomy, laminectomy, or foraminotomy may be necessary. Patients should seek medical attention when the pain occurs after a traumatic injury, the pain is severe, there is a loss of control in the bladder or bowels, or if any part of the body becomes weak or paralyzed. Most cases of neural foraminal stenosis improve on their own or with non-invasive, at-home treatments.8
Chiropractic care can help to treat different forms of foraminal stenosis. The chiropractic adjustments will help take pressure off of the pinched nerves, and proper motion of the vertebrae will be restored. Chiropractors can also recommend exercises and lifestyle changes for the patient to try at home. These include the aforementioned orthotics as well as ergonomic modifications when the patient is sitting for an extended period of time. In general, chiropractors try to avoid medications and they will promote natural solutions. Chiropractic solutions are safer and cause fewer side effects. They often work with doctors and physical therapists as part of the patient’s treatment plan. In many cases, patients will not need more than chiropractic care and at-home changes to treat their stenosis. Severe cases that require serious treatment are rare, fortunately.9
Want to know more about spinal stenosis and chiropractic care?