The spine is made up of 33 vertebral bones. Each the bones has a large central canal opening for the spinal cord. Additional openings on each side of the spinal cord called foramens allow the exiting nerves to branch out from the spinal cord to the arms, legs and other parts of the body. The foramen is the space where the exiting nerve exits formed by two facet bones (facet Joint) above and the disc between the vertebral bodies below the exiting nerves.
What Causes Foraminal Stenosis?
Normally nerve roots have enough room to exit the spinal canal through the foramen. However, with age, degenerative disc disease and trauma, the foramen can narrow and compress the spinal cord and or exiting nerves. Some other conditions such as bulging or herniated discs, calcified ligaments and bone spurs and spinal arthritis may further affect the foramen. This condition can develop anywhere in our spine from cervical to thoracic and is most common in the lumbar region. The average age of patients suffering from spinal and foraminal stenosis is 55 years of age. The disease may affect women and men of varying ages and physical activity levels.
The patients at highest risk for stenosis are:
What are the symptoms of Foraminal Stenosis?
Compression on the spinal and exiting nerve leads to inflammation which produces many different types of symptoms depending on the severity of the compression. The symptoms experienced among patients can vary depending on the area of the spine affected or compressed. In the cervical (neck) region, symptoms may be experienced in the neck, shoulders and arms down to the fingers. In the lumbar (back) region, symptoms can be felt in the back, buttocks, thighs, knee, calves, feet and toes. The most common symptoms include:
How Is Foraminal Stenosis Diagnosed?
Accurate and thorough diagnosis is key to selecting the best treatment options. The following is part of a comprehensive diagnostic workup:
What Are The Treatment Options For Spinal and Foraminal Stenosis?
As with any spinal condition and depending on the severity of the symptoms, conservative care should always be suggested first before surgical intervention.
When conservative care is exhausted and the patients are still in pain, surgery is a logical step to relieve the pain. Traditionally, central and lateral recess stenosis is performed open with a large incision in the skin. A laminectomy and or facetectomy are performed to release the pressure on the spinal cord. Unfortunately, this technique is invasive and leads to significant post-operative pain and recovery. With innovation and advances in technology, a less invasive surgical technique has been developed to address these painful conditions such as foraminal stenosis.
What Is The Recovery
Most patients can begin getting out of bed one hour after surgery and go home shortly afterward. Activity is gradually increased and patients are typically able to return to work within a few days. There will probably be some pain after the procedure and is usually localized to the incision site. However, always consult your physician before beginning any physical work.
Always seek your physician’s opinion when it is safe to return to work. Also, light administrative duty is recommended until your physician approves of any physical demands at your place of work.
At home, you will need to continue to rest. You will be instructed on how to gradually increase your activity. You may still need to take the pain medications for a while. However, pain and discomfort should begin to reduce within a couple of days after surgery. We will discuss with you other techniques for reducing pain and increasing flexibility before you leave for home. We will also discuss with you a time frame for when you can resume basic activities such as walking, driving and light lifting, and when you can return to more advanced activities such as physical labor, sports, and yard work.