Foraminal stenosis (foraminal narrowing), could be a painful condition that can be treated with chiropractic.
What is Foraminal Stenosis or Foraminal Narrowing?
Foraminal narrowing (foraminal stenosis) is a painful spine condition that results from compression of the spinal nerve root. The nerve roots of the spine run “through the spinal column via small openings called foramina”. If there is narrowing in the foramina, this reduces the space for the nerve roots, causing irritation and can lead to radiating pain, numbness, tingling, or weakness in the muscles affected by that nerve. In general, the aging process leads to “gradual anatomical deterioration”, and that is responsible for most of the foraminal stenosis cases. Wear and tear over the years breaks down discs and vertebrae, especially in the lower back (lumbar stenosis) and neck (cervical stenosis) areas. Typically, only one side (unilateral) narrowing occurs, but sometimes bilateral foraminal stenosis results, which “affects both sides of a vertebral segment”. Some causes of stenosis include herniated or bulging discs, bone spurs, spinal injury, degenerative disc disease, or spondylolisthesis.1 With foraminal narrowing, the pain comes on slowly, developing over years, and it is not continuous. The pain is generally related to some position or activity.2 Arthritis can also cause foraminal stenosis. If the passage for the spinal cord “becomes clogged, the condition is called spinal stenosis”.3
Neural Foraminal Stenosis
Neural foraminal stenosis is the term for this condition that affects the spinal cord, in which there is a narrowing of the openings for the spinal nerves. Those openings, as noted earlier, are called foramen. Disc degeneration is often the cause, although osteoarthritis and rheumatoid arthritis could be culprits. Other causes of foraminal narrowing include tumors and meningitis, and in some cases the condition is present at birth (congenital). The nerve compression occurs over time in a gradual manner. The most common symptoms are tingling, muscle weakness, pain, and numbness. The symptoms themselves “are generally noncontinuous and vary depending on whether it’s cervical or lumbar spinal compression”. Because the symptoms come and go and are gradual in onset, diagnosis is difficult. Diagnostic imaging will likely be ordered.4
Foraminal Stenosis Treatment
Treatments vary, but non-surgical options are explored first. Patients may engage in physiotherapy, adopt lifestyle changes, or they might opt for anti-inflammatory medications or steroid injections. In some cases, decompression surgery is offered.5 Chiropractic care is another treatment option. Chiropractors are experts in musculoskeletal conditions and they can offer manual manipulation for spinal alignment. This can relieve pressure and treat stenosis pain.6 Instead of considering surgery, patients can also look into acupuncture, aromatherapy, or inversion therapy. Inversion tables allow patients to hang at an angle, or they can choose to hang upside down to decompress the spine, improve posture, assist with flexibility, and improve blood flow. Aromatherapy may “alleviate symptoms by interacting with the limbic system”. Acupuncture could “unblock the channels of energy throughout the body”. If all conservative and alternative measures do not work, patients could be faced with surgical options. Some procedures are “minimally invasive”, but all surgeries carry risks. Foraminotomy, and other surgeries, “remove the tissue or bone blocking the foramina”.7
During a foraminotomy, nerve pressure is released in order to “relieve the symptoms of nerve root compression”. It is considered a minimally invasive procedure. An incision in the back is made, and a hole is cut in the vertebra. An arthroscope is inserted to visualize the foramen, “and the impinging bone or disk material (is) removed”.8 The surgery is performed under general anesthesia, which carries its own set of risks. During the procedure, bone is removed to make more room, and a spinal fusion might be performed as well. Anesthesia risks include medication reactions and breathing troubles. As with any surgery, foraminotomy has the risks of bleeding and infection. The spinal nerve may also become damaged. After the surgery, the patient may have only partial relief, or even no relief, and back pain may return in the future. One more risk of the surgery is thrombophlebitis.9 This is a “swelling (inflammation) of a vein caused by a blood clot”. One type of this condition is deep venous thrombosis and the other is superficial thrombophlebitis. Symptoms include inflammation, pain, skin redness, and tenderness or warmth over the vein. The condition is treated with, analgesics, possibly antibiotics, and blood thinners. Clots would have to be dissolved, and “surgical removal, stripping, or bypass of the vein…may be recommended”. Patients are at higher risk of developing this condition if they have a clotting disorder or if they sit for long periods of time (such as during a plane trip). It is important to stretch and drink fluids.10 If a clot travels to the lung, it is dangerous. Clots can cut off the blood supply, causing a “pulmonary embolism”. Surgeries in general carry the risk of deep venous thrombosis, and preventing DVT is taken seriously.11