At one time or another, back pain affects about 80% of the U.S. population. The degree and duration vary greatly. Foraminal narrowing can be a source of chronic or acute back pain.
Foraminal narrowing is a spinal condition that can cause acute or chronic pain as well as other symptoms resulting from spinal nerve compression.
The spinal column is a strong, yet flexible structure that surrounds and protects your spinal cord. It consists of 34 bones: 24 articulated vertebrae and 10 naturally fused vertebra that make up the sacrum and coccyx.
Each vertebra has a vertebral arch and a large, cylinder-shaped body. The arch is made up of the spinous process and a facet joint on each side. Muscles, ligaments, cartilage, and discs are attached to various parts of the vertebra.
The space between the arch and the vertebral body is the spinal canal. The spinal canal houses your spinal cord. There are other openings on the stacked vertebrae called the foramina (singular foramen), where the nerve roots branch out of the spinal cord. At every level of the spine, a pair of spinal nerves exits the spinal column through the foramina.
What Is Foraminal Narrowing
When narrowing (stenosis) occurs in the foramina, there is less space available for the nerve roots to pass through. Foraminal narrowing doesn’t always cause symptoms. However, when there is nerve compression or irritation, it can cause radiating pain along the length of the nerve as well as numbness, tingling, or weakness within the muscle group innervated by the affected nerve.
Causes of Foraminal Narrowing
While some cases of foraminal narrowing are due to genetics, the most common cause is the natural aging of the spine. The foraminal canal can narrow due to degenerative spine conditions that develop with the weakening and deterioration of the spine.
Conditions Causing a Narrowing of the Foramina
Degenerative disc disease refers to the gradual degeneration of the discs that occurs over time as the spine ages. As the discs degenerate, the foramina may narrow and compress the nerve roots. The symptoms may vary, and some people who have disc degeneration do not have symptoms. Below are some of the conditions that can cause a narrowing of the foramina:
• Spinal arthritis
• Trauma and injury
Symptoms of Foraminal Narrowing
In many cases, the symptoms of foraminal narrowing begin gradually and are sometimes mistaken for muscle soreness. However, they almost always worsen over time unless properly treated. The most common foraminal stenosis symptoms include:
• Acute or chronic neck or back pain
• Muscle weakness
• Numbness or tingling in the extremities
• The feeling of pins and needles or extreme heat
• Traveling pain along the nerve’s path (Radiculopathy)
There are rare cases where spinal degeneration and the resulting nerve compression require emergency treatment. Patients who are experiencing bladder or bowel movement incontinence, extreme muscle weakness in the legs, or excessive pain should visit the emergency room immediately. These could be symptoms of a serious spinal disorder including cauda equina syndrome, a serious disorder that needs urgent medical attention.
Diagnosing Foraminal Narrowing
To diagnose foraminal narrowing, your physician will take a detailed medical history and discuss the exact nature of your symptoms. Your doctor or spine surgeon will look for levels of pain, limitations of movement, loss of reflexes, and other symptoms. In addition, they may order diagnostic imaging tests such as x-rays, CT scans, and MRI to rule out tumors, injuries, or abnormalities, assess the damage to soft tissues, and see the size, shape, and nearby structures in the spinal canal.
Treatment for Foraminal Narrowing
Often the pain caused by foraminal narrowing can be relieved through nonsurgical, conservative treatment. These treatments are designed to reduce inflammation and provide pain relief as well as strengthen the muscles that support the spine.
Non-surgical treatment options may include:
• Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs)
• Prescription pain medication
• Physical therapy
• Hot/cold therapy
• Behavior modification techniques
If conservative, non-surgical treatment methods provide little or no pain relief after a few months, your physician may recommend a surgical intervention. Surgical procedures may include:
• Foraminotomy – to create more space in the foramen
• Facetectomy – to relieve spinal pressure
• Discectomy – to remove a diseased portion of a disc causing nerve compression
• Facet Thermal Ablation – to vaporize irritated and painful nerves around the facet of the vertebrae
Your spine surgeon will consult with you about which procedures are appropriate for your condition.
Prevention & Self-Care
Foraminal narrowing is a degenerative condition that develops with age. While you may not be able to prevent its development completely, there are some steps you can take to slow it down and keep the components of the spine as healthy as possible.
• Don’t smoke and drink moderately
• Consume plenty of food low in saturated fat and high in omega-3 fatty acids and calcium
• Drink plenty of water
• Regular, gentle stretching
• Avoid pulling or lifting heavy objects
• Lose weight – obesity can put additional pressure on your spine