Neural Foraminal Stenosis is the condition where the openings along the spinal column narrow down, resulting in the compression of the spinal nerves.
In this article, we will understand all about Neural Foraminal Stenosis: look at the symptoms of this condition, understand what causes it, and explore the available modes of treatments. Gaining a clear understanding of this condition would also help you to undertake measures to prevent it.
What Is Neural Foraminal Stenosis?
The openings between the vertebrae along the spine, through which the nerves enter and exit the spinal column, are called foramen.
The foramen plays a major role in relaying messages between the brain and the other body parts, by conducting the nerves out of the spine. These openings are present on either side of the spine.
Due to numerous reasons, the foramen can become narrow. When this happens, the nerves get constricted, and this produces various symptoms including pain, numbness and restricted movement.
It is also known as Neural foraminal narrowing.
This condition usually affects a single nerve on one side of the spine. However, some individuals may experience narrowing on both sides of the spinal column, a condition known as bilateral neural stenosis.
Types Of Neural Foraminal Stenosis
Neural foraminal stenosis can occur in any part of the spine. Here are the different types of Neural Foraminal Stenosis, depending on the region affected:
a. Cervical Foraminal Stenosis
This affects the neck, shoulders, upper back, arms, and fingers.
b. Thoracic Foraminal Stenosis
This affects the rib cage and internal organs.
c. Lumbar Foraminal Stenosis
This affects the lower back, buttocks, and legs.
The upper back (cervical region) and the lower back (lumbar region) are most commonly affected, due to degeneration that results from constant stress and movement in these regions. Around 70 percent of the cases of neural foraminal stenosis affect the lower lumbar region.
A Quick Look At The Spinal Column
The spine, also known as the backbone, helps us to stand upright, maintain balance and perform various movements.
It comprises of a series of bones, called vertebrae, that are positioned one over the other in an S-shape.
Our spinal column is made up of 33 vertebrae, which interlock with each other. They protect the spinal cord from injury and support the body.
The vertebrae are divided into regions and carry out different functions. These regions are:
- Cervical: This region consists of the vertebrae C1 to C7. They support the head and allow a range of neck movements.
- Thoracic: This region consists of vertebrae numbered T1 to T 12. Their primary function is to support the ribcage and protect the lungs and heart. Movement of this region of the spine is limited.
- Lumbar: This region includes vertebrae L1 to L5. They support the weight of the body and help to lift, balance and carry heavy objects.
- Sacrum: This consists of five vertebrae that are fused together. These are connected with the hip bones to form the pelvic girdle.
- Coccyx: This is made up of four fused bones.
The spinal canal runs centrally through the entire length of the spinal column and houses the spinal cord.
The spinal cord is a long bundle of nerves and nerve cells, extending from the brainstem to the lumbar vertebrae. It measures about 18 inches in length, with thickness varying from half an inch to one-fourth of an inch in some areas.
Nerves branch out from the spinal cord, to carry information from the brain to the body and vice-versa. The spinal cord also has the important function of reflexes, which result in quick actions to prevent damage to the body.
Symptoms Of Neural Foraminal Stenosis
Although the foramen narrows, it may still allow sufficient room for the nerves to pass through, without affecting their function. In such a case of neural foraminal stenosis, people usually would not experience any symptoms.
However, a condition where the foramen constricts to the extent that it pinches the nerves would result in symptoms. Hence, we can understand that the narrowing of these openings alone does not produce any symptoms. The pressure on the nerves, as a result of the shrinkage, is what produces symptoms.
- Numbness or loss of sensation
- Weakness of the muscles
- Restriction of movements
- Tingling sensation
- Muscle spasms
As discussed earlier, neural foraminal stenosis can affect varying regions of the spine. Hence, it produces symptoms in different parts of the body, depending on the nerve affected.
Individuals may experience gradual symptoms locally at the site of constriction or in anywhere in the body, through which the nerve travels
Majority of the cases of neural foraminal stenosis affects the lumbar region, producing pain and other symptoms in the lower extremities including, the lower back, buttocks, and legs. Some people may even find it difficult to stand upright or walk.
Intermittent symptoms due to physical exertion can be temporarily relieved when the person sits to rest for a while.
In extreme cases, some people may lose control of their bladder or bowel movement.
What Causes Neural Foraminal Stenosis?
The most common cause of neural foraminal stenosis is degeneration of the spine due to aging.
With the normal process of aging, the spinal column undergoes wear and tear. It becomes prone to deterioration and inflammation. This results in degeneration and narrowing of the foramen.
Factors that lead to neural foraminal stenosis include the following:
i. Herniated Disc
This is the condition where a portion of the spinal disc projects into the foramen, thereby constricting the nervous tissue.
The spinal discs between the vertebrae become more vulnerable to injury with progressing age and may lose their elastic nature. As a result, stress in the body can easily lead to rupture of the disc. This is what causes a herniated disc, otherwise known as the slipped disc.
This most commonly occurs in the lower lumbar region.
ii. Bulging Disc
The spinal intervertebral discs are the cushioning between the vertebrae along the spine, which absorb shock and protect from injury. These discs comprise a soft, jelly-like inner portion and a thick layer on the outside.
A bulged disc happens when the inner portion of the spinal disc protrudes from the outer wall of the disc. By exerting pressure on the nerves, it can lead to pain and discomforts
iii. Degenerative Disc Disease
This refers to the natural changes in the spinal discs due to aging. Factors such as age, injury or infections can cause the soft inner portion of the disc to deteriorate, while the outer layer can become stiff, bulge out or rupture.
The disc loses its ability to efficiently absorb shock, loses its elastic nature and becomes rigid. When this condition affects the nerves, it can lead to neural foraminal stenosis.
iv. Bone Spur
Projections of the bone, termed as osteophytes, can form along the spinal column, which may compress the nerves of the spinal cord. These can be caused by natural aging or by conditions like osteoarthritis.
This is the slipping of the vertebrae of the spinal column. The vertebra is displaced from its original position by slipping forward or backward. When this vertebra pinches a nerve, it can cause foraminal stenosis and produce symptoms.
vi. Facet Disease
Facet joints are small joints in the spine that connect the vertebrae. These can sometimes harden to narrow down the foramen, which constricts the spinal cord.
- Prolonged or repetitive activities that involve stress on the spine.
- Spinal arthritis
- Spinal injuries
- Weight gain and obesity that place stress on the spine.
- Structural defects since birth
Neural Foraminal Stenosis Diagnosis
If you experience any of the symptoms discussed earlier, which indicate neural foraminal stenosis, it is advisable to consult a doctor. Diagnosis of the condition is the key to understanding its cause and seeking appropriate treatment.
The doctor would normally examine your medical history and inquire about the symptoms, their duration, persistence, and patterns.
They may then conduct a physical and neurological examination to understand the severity of the pain, limited movement, and other abnormalities.
The doctor may recommend taking an X-ray or conduct imaging tests like MRI or CT scan. These procedures help to evaluate the damage to the discs or tissues and confirm the condition.
How To Treat Neural Foraminal Stenosis?
Neural foraminal stenosis can cause pain and discomfort, often making it difficult to perform various daily activities. Accurate diagnosis of this condition will help you to decide on the best mode of treatment.
Treatment of the condition depends on the severity of the foraminal stenosis and its location on the spine.
There are many non-surgical means to treat the condition and relieve the symptoms. These include the following methods, which are sometimes combined for effective treatment in some cases:
1. Medications For Pain Or Inflammation
These include the use of painkillers like paracetamol and non-steroidal anti-inflammatory drugs such as ibuprofen and aspirin.
This helps to restore strength, flexibility, and functioning of the affected areas. It can also ease out pain and discomfort.
Special exercises with low impact on the spinal column and stretching performed under medical supervision. These are particularly effective in the initial stages of the condition.
4. Changes In Lifestyle Activities
Refraining from positions that worsen the condition and practicing postures that relieve the symptoms. Modification of activities can manage symptoms.
5. Ice And Heat Therapy
This is done to reduce the pain caused by the condition.
It is very important that you should decide and pursue these treatment methods under the guidance of a medical practitioner. Otherwise, you may end up aggravating the condition.
The main aim of these methods is to manage the symptoms of neural foraminal stenosis and to help the person perform their daily activities. These do not necessarily cure the condition itself.
If these non-invasive treatment options do not prove to be effective, you may be advised to undergo surgery. Surgical treatment is recommended for those patients whose day-to-day activities are severely affected by the condition.
Factors that need to be considered while deciding on surgical treatment include the location of the stenosis, overall health of the patient, his/her tolerance and response to anesthesia, and facilities to conduct the surgery involving skill and precision.
Types Of Foraminal Stenosis Surgery
There exist different methods of foraminal stenosis surgery. These include:
This is a decompression surgery to eliminate the blockage that causes the narrowing affecting the nerves. It makes space in the foramen to allow passage of the nerves, by removing the tissue or bone that causes the condition.
This surgery removes the lamina section of the vertebrae to relieve pressure on the nerves. A surgeon may also perform the laminectomy to allow sufficient space to conduct foraminotomy.
This surgical method involves removing a portion of the disc that constricts the nerve.
Spinal fusion surgery is often used in combination with some of the above procedures, to fuse together the vertebrae surrounding the narrowed foramen. It improves the stability of the spine.
Thanks to technological developments, today there are minimally invasive surgery options to treat the neural foraminal stenosis. Smaller incisions in this type of surgery would mean lesser recovery time and minimal scars.
Endoscopic Foraminotomy is a minimally invasive approach, performed through an endoscope. This technique uses a camera to see inside and accurately locate the problem. Recovery times are very small when compared to open surgery.
How To Prevent Neural Foraminal Stenosis?
This condition is difficult to prevent since it is most commonly caused by the natural process of aging. However, other factors that lead to the condition can be checked through some preventive measures such as:
a. Maintain normal body weight. Excess weight would put more stress on the spine, which balances and supports the body.
b. Regular exercise strengthens the spine, relieves strain and allows proper functioning.
c. Practise good posture
d. Ensure good ergonomic practices.
e. Identify and eliminate repetitive positions and activities that stress the spinal column.
f. Efficient load bearing and weight management.
As we have seen, the spine is a very important part of the body that manages multiple functions. Any condition that affects the spinal column may result in the inability to perform various activities and even lead to paralysis in extreme cases.
Hence, it is essential to take appropriate measures to maintain a healthy spine.