To understand foraminal stenosis, you have to understand a little bit about the anatomy of a vertebrae. This is because foraminal stenosis is when one part of the vertebrae is affected. In the middle of the vertebral body lies the spinal cord, which travels throughout the entire vertebral column from head to the level of the second lumbar vertebrae.

The spinal cord isn’t just a thick cord. It has many nerves coming from it at the level of each vertebrae up to the second lumbar vertebrae. After this level, the spinal nerves splay outward as a horse’s tail, which is called the cauda equina.

These vertebral nerves connect to different parts of the body. For example, the vertebral nerves of the cervical vertebrae innervate parts of the head, neck, shoulders, arms, elbows, hands, and fingers. The thoracic nerves that emanate from the spinal cord innervate the chest and upper back in the rib cage area. The lumbar nerves innervate the body from the waist down.

Because the vertebral body is round, there has to be a way out for the nerves to travel from the area of the spinal cord to the rest of body. And there is. There’s a hole on each side of the vertebrae that the nerve goes through. This hole is called the foramen.

What is foraminal stenosis ?         Foraminal Stenosis

Foraminal stenosis is defined as narrowing of the canal where the spinal nerve(s) exit the vertebral body.

The narrowing can happen because of arthritis, which can cause bony calcifications on the vertebrae that cover up the foramen and press on the spinal nerve. The narrowing of the foramen can occur because of a herniated disc, or even if the ligaments surrounding the nerve or spinal cord thicken.

Whenever this happens, there will be symptoms that result in the body. One of the symptoms is pain called radicular pain. In this type of pain, the pain isn’t just localized in one small area. Instead, it radiates outward to different areas of the body. The areas that are affected are the areas innervated by the nerve that is affected. Some of the other symptoms of foraminal stenosis include the feeling of numbness, pins and needles, hot and cold sensations and even muscle weakness.

Lumbar foraminal stenosis

By definition, lumbar foraminal stenosis is a narrowing of one of the foramen in the lumbar vertebrae. Each lumbar nerve innervates different parts of the body. Here’s a little chart of the areas innervated by the different spinal nerves.

Spinal Nerve 

L1

L2

L3

L4

L5

 Area Innervated 

Anterior and medial thigh, quadriceps muscle

Hip flexor muscles, Iliopsoas muscles

Hip adductor muscles, Adductor longus muscle, Knee extensor muscle

Vastus lateralis and Vastus medialis muscles

Ankle dorsiflexor muscles, ankle evertors, ankle invertor muscles, and hip abductors

Here are some of the symptoms that occur once the different lumbar spinal levels occur in cases of lumbar spinal stenosis.

Spinal Level 

L1

L2

L3

L4

L5

Symptoms associated with dysfunction 

Constipation, diarrhea, colitis, herniaAppendicitis, cramps in abdomen, varicose veins

Impotency, bedwetting, bladder disorders, menstrual disorders and miscarriages

Painful urination, sciatica, backaches

Weakness in legs and arches of feet, leg cramps, cold feet

What this chart tells us is that when there is stenosis, it’s possible that the muscles associated with the lumbar nerves will be very weak.

Cervical foraminal stenosis

In cases where there’s cervical foraminal stenosis, different muscles could be involved and weakness would result, again depending on the level of the spinal nerve that is affected.

Below is a chart of the cervical spinal nerves and the symptoms that would occur if foraminal stenosis was associated with them.

Spine level 

C1

C2

C3

C4

C5

C6

C7

Symptoms when this spine level is disturbed 

Headaches, insomnia, dizziness, high blood pressure, nervousness, anxiety, mental disorders, anmnesia

Deafness, allergies, sinus trouble, eye disorders

Eczema, acne, neuralgia

Deafness, hay fever, postnasal drip

Hoarseness, laryngitis

Pain and numbness along the thumb and index finger stiff neck, shoulder, outer arm and forearm

Pain and numbness of the middle finger Bursitis, thyroid conditions, tennis elbow

There are 8 spinal nerves because the first spinal nerve comes out at the top of the C1 vertebrae while the second one comes out underneath the C1 vertebrae.

Foraminal stenosis treatment

Foraminal stenosis treatment doesn’t usually occur for quite awhile after diagnosis. This is because in many cases, changing one’s activities may be enough to decrease pain and symptoms. Doctors prefer conservative treatment when it comes to many back and neck disorders. Conservative treatment for stenosis is to use painkiller medications and anti-inflammatory agents such as corticosteroids. Physical therapy is also recommended which can strengthen the muscles.

Foraminal stenosis surgery

The longer the stenosis occurs in a patient, the worse it gets. When the nerve is compressed a small amount, it has the power to recover, especially if the compression is removed quickly. The longer the compression, the more difficult it is to get back to normal. If the compression is worsening day by day, such as from activities that worsen it, then the combination of additional pressure on the nerve root from the stenosis with the added length of time could make symptoms worse, and in some ways incurable.

Out of all the tissues in the body, healing times are the longest for the nervous system. The spinal cord takes the longest to heal and the spinal nerves are next. This is why you should seek medical attention for foraminal stenosis if your symptoms worsen.

Tagged with:

Filed under: Spinal Stenosis