What’s to know about neural foraminal stenosis

Neural foraminal stenosis refers to the narrowing of the small spaces into which nerve roots travel between each vertebra in the spine, called foramen.

A type of spinal stenosis, neural foraminal stenosis, does not always cause symptoms. But this can be uncomfortable if a nerve is trapped in the gap.

Over-the-counter pain relief can improve, such as non-steroid anti-inflammatory drugs (NSAIDs), and medicine that can change nerve pain may be administered by physicians.

Important facts about neural foraminal stenosis:

  • Nerve cells are part of the nervous system, and they carry messages to the brain from all over the body.
  • If a spinal nerve gets compressed, a pain signal is sent to the brain.
  • Symptoms can include pain that may depend on where in the spine the nerve has been compressed.
  • Treatment includes spinal injection of steroids or local anesthetic in long-term cases.

What is neural foraminal stenosis?

Neural foraminal stenosis
Nerves run through the vertebrae of the spine, up towards the brain. Neural foraminal stenosis is when these nerves get trapped in the spine.

Nerves migrate to the spinal canal from all areas of the body. The nerve roots, or foramen, travel through openings in the vertebrae and proceed up the spinal cord to the brain.

The nervous system reacts and activates responses to input from the senses.

For instance, the nerves transmit information that makes the muscles move away from the source of pain when a person senses pain, but at the same time reminding the brain that there is pain.

There is a cell body and many extensions, called dendrites and an axon, in each nerve or neuron. The dendrites receive signals that can be up to a meter long, and pass along the axon. Via the network of spinal nerves, all the signals reach the brain.

Neural foraminal stenosis develops where the nerve root is caught by the foramen of the neck ( cervical stenosis), the upper back (thoracic stenosis), or the lower back (lumbar stenosis), cramped or narrow.

Symptoms

Not everyone with neural foraminal stenosis will develop symptoms. However, if a nerve is trapped, the effects appear to affect one side of the body only and can include:

  • Back or neck pain
  • muscle weakness
  • tingling
  • numbness or weakness in the arm , hand, or leg
  • burning sensations
  • problems walking
  • issues with balance

If the nerve root is squeezed on both ends, it would possibly impact both sides of the body. This is called bilateral foraminal stenosis.

Causes

A Doctor showing her patient x-ray result
Neural foraminal stenosis may be caused by a range of conditions.

As age rises, the likelihood of neural foraminal stenosis, which can be caused by general wear and tear.

The degenerative spine is the most prominent cause of neural foraminal stenosis.

This extends into the canal of the foramin, narrowing the gaps and openings between the vertebrae where nerves exit.

Degenerative disk

A degenerative disk is when the escaping nerve is compressed by a vertebral disc that degenerates and slides out of position. The most frequent condition occurs in the lumbar spine, but it may also occur in the thoracic or cervical spine.

Herniated disk

A herniated disk is also known as a slipped or prolapsed disk, indicating one of the cartilage discs that lies between the vertebrae is damaged.

Spondylolisthesis

Spondylolisthesis is where the front or back of the vertebra behind it slips with one vertebra. It usually occurs in the lumbar spine, but in the spine it may occur anywhere. This will allow the escaping nerve in the foramen to be shortened.

Rheumatoid arthritis and osteoarthritis

When cartilage breaks down, arthritis occurs, and this may also happen to the cartilage discs that lie between the vertebrae.

Osteophyte

In those over 60 years of age, this is a bone spur development in the back that is very normal and typically caused by osteoarthritis.

Trauma

Repetitive trauma to the spine damages the vertebrae and cause it to slip. In athletes, such as gymnasts and weightlifters, this is more popular. A sudden injury will cause a disc slip as well.

Diagnosis

The diagnosis will be made by a doctor based on a physical examination and the findings of an MRI scan. A CT scan may be used in some cases to validate the problem.

Treatment

Treatment varies depending on the severity of the condition.

Exercise

Old man Cycling on a static bike
Usually, cycling is easier than walking for those with spinal stenosis. Cycling on a static bike for a couple of minutes a day is recommended, as a way to begin improving spinal mobility.

As a first step, the British Association of Spinal Surgeons recommends improving spinal stability and overall strength and fitness, adding that, if possible, weight loss can help.

For those with spinal stenosis, the group adds that cycling is also less difficult than walking and recommends riding a static bike, starting twice a day for 2 to 3 minutes and working up from there.

It also implies that a person walks until their level of pain is met, rests, then walks a little more.

A doctor may prescribe an epidural, which is an injection into the spinal canal, if the exercise does not relieve the symptoms. Epidurals tend to relieve leg pain more successfully than back pain.

Injection

Studies suggest that about 60 % of people respond well to this kind of therapy.

Surgery

A doctor can recommend surgery if a person is still experiencing intolerable pain. Any factors will need to be taken into consideration by the doctor: These considerations include:

  • the person’s general state of health, and whether they have any other conditions or health problems
  • their general fitness
  • whether the problem is in one or multiple areas of the spine

The surgical options include:

  • Interspinous distraction device: This procedure involves implanting a device in the space between the vertebrae to widen the gap and relieve pressure on the nerves.
  • Foraminotomy: A surgeon removes the bone that is causing the compression to give the nerves more room.

Takeaway

Everyone responds to medication differently. But 20 percent of persons will improve with time as a general rule of thumb, and 20 percent will worsen. The majority will stay approximately the same.

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