Foraminal Stenosis: The Definitive Guide

What is Foraminal Stenosis?

Foraminal stenosis is a ‘pain the back’ that, if left undiagnosed and untreated, can morph into a very serious and highly impactful condition. Here is what you need to know about foraminal stenosis. Foraminal stenosis is when the foramen, which is an opening or gap between vertebrae and the spine nerve exits, is constricted and compresses against the spinal cord and/or the spinal nerves.

The condition known as foraminal stenosis involves the narrowing of the patient’s spinal foramen, the hole a spinal nerve passes as it exits the spine. Foraminal stenosis also is defined as the narrowing of the cervical disc space. Foraminal stenosis is only one of the many forms of spinal stenosis (otherwise known as cervical spinal stenosis) that–according to The American Academy of Orthopedic Surgeons–afflicts 8-11 percent of the population. Other sources report a significantly higher percentage, with Healthline stating that nearly 50 percent of those entering their middle or senior years suffer from some form of stenosis or pinched nerves.

Commonly referred to as baby boomer back, spinal stenosis is known to disproportionately affect people over age 50. It should be noted that even teenagers can develop this condition, though the condition does take some time to develop. In general, the condition involves the narrowing of the spinal canal; yet the variety and name of the specific stenosis condition will depend on the location of the malady.

In particular, foraminal stenosis basically can affect the entirety of the spine; this owing to the fact that individual foramen resides at every level of the spine, with one resting on each side. That’s right; at each and every level of the spine, a spinal nerve–one coming to or from the spinal cord–passes through a foramen. And as the foramen is a smaller scale anatomical region, anything that touches or intrudes upon that region can lead to a potentially painful case of foraminal stenosis.


picture of lumbar foraminal stenosis

It is an enlargement of the joint, and the incurring sensitivity and delicacy of a nerve root on one side, that causes foraminal stenosis. Yet before we delve too deeply into this problematic condition, it is important to remember the vital role that the spinal column plays in the life, body and overall health of a human being.

Foraminal stenosis is only one of a multitude of serious conditions that can affect the spinal column; a virtual anatomical nerve center that runs all the way from the base of the brain to the backbone, including the vertebral canal. The brain and spine together form the central nervous system.

The spinal column basically serves to support the entire anatomy, empowering us to stand, twist and bend, also shielding the spinal cord from any form of harm or injury. Any such condition could serve to rob the body of strength, feeling, and those basic, essential functions that enable us to live, work and spend quality time with our friends and families each day.

The primary functions of the spinal cord include electrical communication, the facilitation of walking ability, the body’s full and comprehensive set of involuntary reflexes, and other vital bodily purposes and activities.

It goes without saying that any harm to the spine can seriously impact the patient’s existence; and this is particularly true of any and all instances of foraminal stenosis, which–along with other forms and varieties of spinal stenosis–are frequently referred to as pinched nerves. Whenever a foreign object restricts and exerts undue pressure on the spinal nerves, then the condition known as pinched nerves can result.


picture of foraminal stenosis causes


Foraminal Stenosis Causes

Foraminal stenosis causes can be just as varied as the condition’s effects; in general, though, the majority of instances can be traced to a single cause or source. Indeed, with most instances of spinal stenosis, advanced age is the root of most cases of foraminal stenosis. As people age, and as their bodies undergo day after day and year after year of both normal and vigorous physical activity, their spinal column degenerates. And those who–due to work, sports, or other vigorous physical activity–perform more physical activity than others are more liable to develop foraminal stenosis and other varieties of degenerative spine disease.

This can happen to even the healthiest and most active of older adults; and if the patient is dealing with other orthopedic health conditions, such as bulging discs, herniated discs (in which the intervertebral discs that cushion each of the spine’s vertebral spine bone protrude to very painful effect), bony growths or spurs (in which the cartilage roughens or wears, permitting bones to rub against each other and in turn leading to the emergence of small bone spurs or growths, and the swelling of soft tissues. Various intrusive growths and tissues can impinge or have a serious impact or effect upon the foramen–compressing or exerting undue pressure on the nerves of the spine.

Osteoarthritis, a condition in which the spine’s cushioning cartilage begins to degenerate with age, often is cited as the most major and frequent cause of foraminal stenosis. Also known as spondylosis, spinal osteoarthritis–although generally not life-threatening–is known to be a very painful and life-impairing condition. A degenerative condition that can affect and impact any region of the spine, osteoarthritis can impair the spine’s intervertebral discs and facet joints–reducing the amount of space between vertebral discs and impeding the patient’s movement; also leading to related conditions such as bone spurs and foraminal stenosis.

In other words, this particular spinal disorder often happens as the direct and (pun fully intended–so sorry) pressing effects of other orthopedic conditions; and just how impactful or widespread the condition is will depend on the number of foramina affected.


Foraminal Stenosis Symptoms

Foraminal stenosis symptoms can be attributed to other causes and sources. Stenosis can be both primary or congenital; meaning that the condition was inherited at birth.  the Foraminal stenosis symptoms may not display themselves until the patient in question reaches his/her middle-aged or advanced years. In rare cases, the disease can be attributed to spondylolisthesis, tumors or cysts, a bone disease such as Paget’s disease, and genetic conditions like dwarfism.

foraminal stenosis can be indicated through the appearance of symptoms that–while uniformly serious and painful–tend to vary more than slightly from case to case. This is owing to the fact that, as stated earlier, the foramen is found on each individual level of the spinal column. In any given instance of foraminal stenosis, the foramen pinches one or more individual nerves. It is the location of the pinched nerve or nerves that determines the specific symptoms.

To get even more annoyingly technical and endlessly and unapologetically confusing, every single foramen encloses one nerve that travels to a specific and particular anatomical region. A foramen situated on the right side of the body will, most naturally, contain a nerve that travels to that side of the anatomy.


picture of foraminal stenosis treatment


It only stands to reason that this particular instance of foraminal stenosis will occur on the right side of the body–affecting both the motor and sensory function in that area.

When foramen disease strikes the spine’s lower region, it is likely to affect the leg. When the foramen is located in the neck or the cervical area, by contrast, the arm is far more likely to be afflicted.

An exception to this general rule would occur in the instance that foramen on both sides of a particular nerve have been in some way impacted or inflicted.

Regardless of the location of the foraminal stenosis condition, the symptoms themselves actually can be fairly uniform in the vast majority of instances. Patients tend to experience disturbing instances of sensory symptoms that include numbness and tingling, along with either dull or sharp pain and burning sensations; as well as motor symptoms that include weakness, reflex problems, as well as that prickly, tingly sensation frequently described as the ‘pins and needles’ feeling. Most people have experienced the pins and needles feeling at some point during the course of their lives, when their leg ‘falls asleep,’ so to speak, after a period of rest or idleness. Yet if this particular sensation happens to strike more frequently than usual, and on one side of the body as opposed to the other, then it may indeed be an indicator of foraminal stenosis. And the condition also can result in a general loss of function, with some patients at least temporarily suffering a concerning loss of feeling and/or movement.

Even more seriously, people suffering from foraminal stenosis may have difficulty walking or even standing up straight while afflicted. In particularly severe and extreme cases, foraminal stenosis even can result in paralysis.

That’s right; unfortunately, even paralysis can occur as a direct result of foraminal stenosis–and, as is generally characteristic of this serious orthopedic disorder, any instance of paralysis will strike only one side of the body; with the specific muscles immobilized those controlled by the nerve being pinched.

Just to clarify, for those who may express grave concern at this concept; not every case of foraminal stenosis can or will result in even temporary paralysis. This symptom is most likely to occur if the foraminal stenosis is left undiagnosed and/or untreated. If this condition is ignored or simply not noted or detected, then afflicted nerves may eventually die; which, in turn, can lead to and produce a critical loss of function in the human body.


Lumbar Foraminal Stenosis

Foraminal stenosis, at least in its most common form, is often referred to as Lumbar Foraminal Stenosis; this owing to the fact that the condition of foraminal stenosis most commonly strikes the lumbar or lower back section of the spine.

Foraminal stenosis can be a difficult condition to diagnose, both because of the varying locations of its symptoms, and the similarity of many of these telltale signs to other orthopedic conditions. Some of these symptoms, in fact, can come about because of conditions that do not even remotely involve the spine. This is why, if you begin to experience the symptoms of foraminal stenosis with any degree of regularity, it is of extreme importance that you consult an orthopedic physician; one who will, in all likelihood, administer MRI scans of the spine–often considered the ideal imaging tests to examine small and particularly subtle areas of the spine that include the foramen.



picture of foraminal stenosis c5 c6


Foraminal Stenosis C5-C6 Condition

Aside from diagnosing the general condition of foraminal stenosis, the MRI may indeed help to determine the location and classification of this condition in the body of this particular patient. For example; in the condition classification known as foraminal stenosis c5-c6, the disorder strikes the C5-C6 vertebrae along with the disc situated between them. Situated just beneath the center of the cervical spine, this section of the spine, in particular, helps to supply the neck with structural support and flexibility.



picture of Foraminal Stenosis I5 S1


Foraminal Stenosis I5 S1 Condition

Another common instance of foraminal stenosis, foraminal stenosis l5 s1, afflicts the L5 and S1 vertebrae in the lower spine; the very point at which the nerve roots branch away from the spinal cord and down the legs. These vertebrae mark the site at which the last vertebra of the lumbar spine (l5) meets the sacrum’s top; creating a junction called the lumbosacral joint.

Once any given condition of foraminal stenosis is diagnosed, then the patient’s next logical question will be, “what is the treatment for severe foraminal stenosis?” This will be true, in fact, regardless of the condition’s severity, this due to the fact that any condition of foraminal stenosis can severely limit the everyday activities and limit the life of the patient.



picture of treatment for severe foraminal stenosis


Foraminal Stenosis Treatment

Luckily for these concerned patients and their families, a variety of foraminal stenosis treatment options are available. The options that the physician and patient team choose to pursue will depend on the severity and degree of the foraminal stenosis condition in question.

The good news is that, in the vast majority of cases, an instance of relatively mild foraminal stenosis can be treated via a brief regimen of rest. Avoid vigorous or strenuous activity, if possible, and just take it easy for a few days. This may serve to rest and repair pinched nerves, however–as is the case with the trauma that may have caused the condition in the first place–it is important not to overdo it; to refrain from any and all activity for too long. This is owing to the fact that your body needs some form of regular exercise in order to thrive and survive.

Along these same lines, a regimen of light exercise and stretching might help to loosen pinched nerves and stabilize your spine–enhancing one’s range of motion and creating more available space through which the nerves can pass. A certain designated series of stretches–up to and including the sitting spinal stretch, the standing hamstring stretch, the knee to opposite soldier, etc.–can when performed carefully and as per the direction of a doctor or certified personal trainer, help alleviate the effects of a foraminal stenosis condition.

Hot and cold treatments also can be useful in treating and helping to resolve this condition. Apply cold packs to the afflicted region for the first few days following the diagnosis, then switch off if still needed to warm packs or heating pads. Cold pads in themselves serve to soothe and numb any pain or discomfort caused as a result of foraminal stenosis.

For more severe cases of foraminal stenosis, other, more intensive methods of treatment and healing might be prescribed. For one thing, NSAIDs such as aspirin, or steroids such as prednisone, might be recommended. A change in diet even might be suggested strongly, as weight loss can take pressure from the spine and nerve roots. And, for a very brief period, the physician might apply the use of a neck brace or soft cervical collar. This move will restrict your movement and relax your neck muscles.





picture of foraminal stenosis surgery


Foraminal Stenosis Surgery

If these methods of treating foraminal stenosis prove unsuccessful, then the physician/patient team may indeed wish to consider options in regards to foraminal stenosis surgery. Although no one likes to consider the possibility of surgery, especially in a pivotal and sensitive area such as the spine, today’s medical technology offers some high tech, minimally invasive surgical procedures custom designed to treat and hopefully resolve foraminal stenosis.

Probably the most common form of surgery to treat foraminal stenosis is a Foraminotomy. In this procedure, the afflicted nerve is decompressed. The surgeon removes the bone and tissue overlying the foramen. This procedure opens the foramen, thus allowing the nerve within considerably more room to pass and move. And luckily, this variety of surgery can be conducted by way of a small incision, through an operation considered to fall into the category of minimally invasive procedures.

To explore these options and others, do not hesitate to consult Dr. Payam Moazzaz regarding your foraminal stenosis condition.


Dr. Payam Moazzaz has accrued a decade’s worth of experience in the orthopedic field and has achieved in particular numerous milestones in the exciting field of minimally invasive surgery and its innovative subset, robotic spine surgery. He ranks among the first surgeons to perform robotic spine surgery via a first-generation platform that earned FDA approval in 2011; and he stands as among the first physicians to use a robotic spine surgery platform called Mazor X, which was introduced on a national level in 2016. Dr. Moazzaz has performed more than 500 spine surgeries using robotic technology, which is the most robotic spine surgeries in the State of California. Moreover, Dr. Moazzaz is the only physician in the state of California to achieve a perfect, 100 percent record of successful surgeries.

Using the very latest in high tech medical technology, robotic surgery involves the advanced use of imagery to eliminate much of the muss and fuss of traditional surgery (to use, of course, the most technologically advanced terms possible).

The process involved with this form of spinal surgery begins several days before the actual procedure, when images are taken of the patient to generate a sort of three-dimensional image of the spine; an image used to create a blueprint for the foraminal stenosis surgery, pinpointing the specific areas that require the surgeon’s attention; in this instance, the afflicted foramen of the spinal column.

This advanced, minimally invasive form of foraminal stenosis surgery saves the patient from an excessive amount of poking and prodding. Armed with their detailed three-dimensional images, the surgeon inserts miniature surgical instruments through smaller incisions via robotic arms; giving the surgeon an unlimited range of motion and precision.

A high-definition, three-dimensional camera directs the surgeon through the surgical procedure by way of a computerized monitor and console; and by accessing this interior view of the patient’s back, the surgeon performs each move of the surgery with the able aid of their robotic counterpart.

The advanced technology of robotic science has revolutionized the entire field of foraminal stenosis surgery, and even minimizes foraminal stenosis surgery risks. In general, this brand of spinal fusion surgery will experience a less painful surgical procedure, one involving a smaller quantity of blood loss, fewer complications, and a much faster return to regular activities via a far more abbreviated foraminal stenosis surgery recovery time.

Plus this singular variety of foraminal stenosis surgery often results in reduced instances of infection, along with less overall damage to skin, muscles, and tissue. These factors alone will help to ensure a more abbreviated surgery recovery time, and shorter hospital stay, this hopefully (if all goes well) guaranteeing that your experience after foraminal stenosis surgery is far more comfortable and easier to cope with–and that, as an added bonus, you will make a smoother, more expedient return to work, family, and social/recreational activities of your choosing.

The condition of foraminal stenosis can cause you great pain and discomfort, hindering both your daily activities and your life in general.  Yet thanks to the marvels of modern technology and the expertise of physicians like Dr. Payam Moazzaz, you can indeed recover from just about any and all instances of foraminal stenosis, soon returning in full to an active and successful existence. Contact New Era Spine today to arrange a consultation with Dr. Payam Moazzaz on the subject of spinal contusions.

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