Narrowing of the foramen (opening) resulting in compression of the nerve roots is known as foraminal stenosis. The narrowing can be caused by development of osteophytes (bone spurs), hypertrophy and thickening of spinal ligaments, a bulging or herniated disc, or a tumor.
This condition commonly develops over time and is often seen in those over 50 years old.
Symptoms vary based on area of the spine affected and amount of compression present. Pain complaints tend to be radicular in nature which includes radiation to the arm(s) or leg(s). Pa-tients often describe a sharp or dull pain, burning sensation, tingling and numbness. Back or neck pain may or may not be present. Certain activities such as walking and standing tend to cause or aggravate symptoms.
The examination may identify loss of motor control, reflex loss, and/or loss of sensation. Some patients will have a normal exam despite symptoms.
The diagnosis of foraminal stenosis is often made following a review of the patient’s history, physical examination and diagnostic studies. Studies often include x-rays to rule out tumors or other bony abnormalities. MRI is usually the standard for identifying the levels of involvement and amount of neural compression. In some cases, a CT scan may be ordered to evaluate the bony architecture and for those who are unable to have an MRI. A CT myelogram may also be useful to more closely define compression on the spinal nerves.
Treatment is aimed at reducing symptoms and initially begins with activity modification, NSAIDs, and physical therapy. Corticosteroid injections, including epidural steroid injections may be in-dicated for radicular pain that does not settle down with initial treatment.
Surgery for foraminal stenosis is often limited to a specific subset of patients who fail to improve with conservative treatment, have corresponding radicular complaints, and have certain findings on diagnostic studies. Various surgical techniques are available based on the presence of con-current stenosis in the central canal, the presence of a disc herniation, and whether or not the potential for instability exists. Surgical outcomes vary by area of the spine affected, patient se-lection, and operative technique.