Foraminal Stenosis/ Neuroforaminal Stenosis/ Foraminal Narrowing
Foraminal Stenosis refers to a narrowing of the opening on the side of each vertebra at the disc level where the spinal nerve roots exit. It is a condition that can cause pain in the low back or neck. But when you have neuroforaminal stenosis or narrowing, it’s likely that you may have impingement of the exiting nerve root. Therefore, neuroforaminal narrowing can lead to pain, numbness, weakness, or tingling in your arms or legs, too!
Understanding Foraminal Stenosis
There are many potential causes of stenosis, it used to be thought of as only a degenerative condition of the spine, but as the definition states—it’s a narrowing of the opening where the nerve root exits So in order to understand what can narrow the neuro foramen, it’s important to look at the anatomy of the spine.
The anterior part of the spine (front) is made up of the vertebral body and the disc, it is the largest part of the spine as it’s also the weight bearing portion of the spine. The vertebral bodies are joined to the back of the spine by a structure called the pedicle—which can be fractured or weakened from birth and create something called a spondylolysis, and a spondylolisthesis.
The pedicle attaches to the facet joint and then the lamina and spinous process at the back of the spine. So, the borders of the neuroforaminal canal are essentially made up of the vertebral body, the intervertebral disc, the facet joint and a ligament called the ligamentum flavum, which connects from the lamina of one vertebra to the lamina of the one above and below. There is also a capsular ligament around the facet joint.
So, what could possibly go wrong to cause neuroforaminal stenosis?
Essentially, anything that effects any of the structures bordering the canal could potentially cause stenosis. Let’s look at them.
Degenerative Disc Disease (DDD) is a condition where the nucleus of the disc loses its water, and the annulus of the disc weakens and dries out causing the entire disc structure to being to collapse. This can lead to disc bulges, disc herniations, and often bone spurs on the edge of the vertebral body. If the bone spurs get big enough, they can cause a bony narrowing of the canal leading to neuroforaminal stenosis.
While we see a fair amount of degenerative disc disease and bone spurs off the lip of the vertebra, we rarely see it as the only cause of neuroforaminal stenosis. It does happen, but it is fairly infrequent. What often happens is the disc begins to dry out or become a desiccated disc, it alters the way your disc can distribute weight and the forces it is subjected to on a daily basis. As the disc weakens, it can bulge out — something we call a bulging disc (or disc bulge). As the disc bulges outward, it pushes into the neuroforamen, leading to neuroforaminal stenosis. In the same way, as the disc weakens, you may move in such a way that the disc suffers a catastrophic failure. This could cause a disc herniation, which might be a disc protrusion, a disc extrusion, or a disc sequestration — a breakdown of those definitions can be found on another page here.
When a disc herniates posteriorly (backwards), it can and will most definitely cause neuroforaminal stenosis. Interestingly enough, disc bulges tend to be broader, even though there is less damage to the disc. They contribute to spinal stenosis more frequently. Disc herniations tend to be more focal and lead to neuroforaminal stenosis.
If your disc breaks down, as in degenerative disc disease, or when your disc bulges from a disc herniation, it alters the distribution of forces that the disc is designed for. When this happens, stress is put on the other structures of your spine that aren’t designed to be weight bearing. This can then cause those structures to hypertrophy, or enlarge, which can contribute to neuroforaminal stenosis.
An extremely effective means of treating a neuroforaminal stenosis is Non-Surgical Spinal Decompression. Non-surgical spinal decompression allows us to reduce the compressive force on the disc, allowing us to reduce the disc herniation size and restore normal function to the disc. This can then remove the pressure on pinched nerves in the neuroforamen caused by all the conditions of a disc that can cause foraminal stenosis. It reduces and eliminates the pain caused by them.
In addition, we do many other therapies designed to improve strength and mobility to your spine, hips, and neck to reduce the likelihood of re-injury. Non-invasive, non-surgical decompression should always be tried before surgery, after a proper neurological examination has been performed to determine if you are a good candidate for this procedure. There will likely be many other specialized services that we will treat you with and teach you, to you to help you recover your lost function. Find out if you are a candidate for our alternative treatments for foraminal stenosis.