How Foraminal Stenosis is Diagnosed and Treated

TreatmentsSpinal Conditions

Chronic back pain sufferers are certain of only one thing: that their back really hurts and keeps on hurting. But they may not know about a condition called “foraminal stenosis”: a narrowing in the openings between the vertebrae in the spine. The symptoms can include tingling in the arms and legs or even problems walking, according to Kaixuan Liu, MD, PhD, founder and medical director at Atlantic Spine Center.

The fact is, a substantial percentage of back pain patients are coping with foraminal stenosis, which is most common in adults age 50 and older, Dr. Liu says. But what is it? Foraminal stenosis means spinal nerve roots, which weave through small openings known as foramina at all levels of the spinal column, are being compressed or pinched. This narrowing is called “stenosis” and can lead to pain, tingling, numbness, and/or weakness in the arms and legs, depending on which limb is closest to the compression.

“Certain positions or movements can cause a frustrating level of discomfort for patients with foraminal stenosis,” Dr. Liu explains. “Various other back conditions can lead to similar symptoms, so visiting a spine specialist can help pinpoint this diagnosis, which is really crucial if you’re experiencing lingering, nagging, back pain, numbness and/or weakness. Foraminal stenosis can really hamper your ability to just enjoy your life.”

Diagnosing Foraminal Stenosis

If you’re diagnosed with foraminal stenosis, it’s important to understand that it’s not your fault and that you likely couldn’t have avoided it from developing in the first place, Dr. Liu notes. Aging is one of the top causes of foraminal stenosis, followed by other problems such as bulging or herniated spinal discs, bone spurs, degenerative disc disease, which causes discs to break down, and spondylolisthesis, which is when bony spinal vertebrae slip over each other.

How do doctors diagnose foraminal stenosis? The patient’s clinical history and physical examination are critical. The pain associated with nerve symptoms such as burning, tingling, numbness, and weakness suggests a pinched nerve from foraminal stenosis. Additional tests such as an MRI, a nerve block study to determine where the pain is originating from, or nerve conduction testing/EMG may be important to determine which nerve is pinched, where the foraminal stenosis is, and how severe the nerve injury is.

“As with most medical conditions, getting an accurate diagnosis is key,” he says. “When we know that foraminal stenosis is the cause of a patient’s symptoms, it empowers both patient and doctor to tailor a treatment approach that improves symptoms and ideally restores them to pain-free living.”

Tips for Treatment

What can be done to treat foraminal stenosis? If diagnosed early, conservative, non-surgical approaches usually work, Dr. Liu says. Some of these treatments often can be done at home and include:

  • NSAIDs (nonsteroidal anti-inflammatory drugs) such as ibuprofen, naproxen or prescription versions, which decrease inflammation
  • Activity changes
  • Physical therapy and prescribed exercises
  • Epidural cortisone injections, which are administered in a doctor’s office

Sometimes conservative measures don’t adequately lessen a patient’s pain or discomfort from foraminal stenosis, however. If that happens, Dr. Liu considers a minimally invasive surgery known as an endoscopic foraminotomy. During this procedure, surgeons insert a small metal instrument into a tiny incision in the patient’s back. Endoscopic tools that are used through this small tube remove debris such as bone spurs, scar tissue or ligament overgrowth that’s causing the foraminal stenosis symptoms.

“Surgery isn’t needed for the vast majority of foraminal stenosis patients, but those who can’t walk very far without sitting to relieve their pain typically are good candidates,” Dr. Liu says. “Whether conservative or surgical measures are needed, most with foraminal stenosis patients will be able to happily go back to their everyday lives.”

For a quick educational video and more info on Stenosis in the spine visit our What is Foraminal Stenosis page.