Foraminal Stenosis, with Great Video Tutorials
foraminal stenosis causes, symptoms, treatments
I have foraminal stenosis. Ever heard of it? I hadn’t, until a few years ago, when I found out that I have it. I’d been having a lot of tingling, numbness, and pain in my neck, shoulder, and left arm. I was also experiencing lower back pain and pain and tingling down my right leg. I tried to shrug it off for months, but the back pain was almost unbearable on some days. It became very difficult to walk or stand, and sometimes it was even hard to sit up in a chair. I finally forced myself to go to my family doctor. I hate going to the doctor, by the way. She thought I might have fibromyalgia, but I didn’t think so. I knew a little about fibromyalgia because a good friend has it, and my symptoms were very different than the ones she experiences.
My physician moved out of town soon after I saw her that last time, and I was assigned to her partner. He didn’t think I had fibromyalgia, so he sent me to a specialist. The specialist felt sure that there was some sort of nerve damage that went along with my back pain, so he ordered MRIs of my cervical spine and of my lumbar spine. That’s when I was diagnosed with foraminal stenosis. I really didn’t understand what that entailed, so I began to research.
To really understand foraminal stenosis, you first must have a good idea of the construction of the vertebral column, or spine. It consists of thirty-three vertebrae that are stacked on top of each other. Twenty-four of these vertebrae can move, and nine are fused together. The twenty-four articulating vertebrae are divided in three sections – the cervical spine, which includes the neck; the thoracic spine, which includes the mid-back; and the lumbar spine, which makes up the lower back. The nine fused vertebrae are part of the sacrum and the coccyx.
Each vertebra has a vertebral body at the front, along with a neural arch at the back. Between each vertebrae are two foramina – one foramen on each side. Foramen means “opening” or “hole,” and that’s just what the foramina are. They’re openings through which nerves pass from the spine to other parts of the body. Stenosis means “closing” or “narrowing.” In layman’s terms, foraminal stenosis means “narrowing of the opening,” or in this case, the narrowing of the hole through which the nerves pass. The common term for this is “pinched nerve” or “impinged nerve,” and it can cause severe back pain.
Causes of foraminal stenosis
Foraminal stenosis is usually caused by degenerative changes in the spine. These can include bulging discs, herniated discs, bone spurs, or swelling and thickening of ligaments. Spinal arthritis is a chief cause. An enlargement of the ulcinate process can also cause foraminal stenosis of the cervical spine. The ulcinate process is the hook-shaped edges on the top surface of cervical vertebrae. Anything that makes the individual foramen smaller can interfere with the nerve that exits there.
Symptoms of foraminal stenosis
Symptoms of foraminal stenosis usually include neck, shoulder, or back pain, numbness, tingling, and weakness. Range of motion is also often restricted. Where you experience these symptoms depend on which nerve is being compressed. Each nerve leads to a different part of your body. If a foramen on the left side of your spine is affected, you’ll have symptoms on that side of your body. If it’s the right foramen that’s encroached, your symptoms will be on the right side of your body. For example, I have encroachment at my left C-5 and C-6, so my left shoulder and arm are affected. I once described the pain I had to my orthopedic surgeon as “an electric toothache.” He said that was the most apt description he’d ever heard for foraminal stenosis pain. It doesn’t hurt all the time, but sometimes I have other strange sensations. It feels just like bugs crawling on my arm sometimes. As a matter of fact, the first few times I felt the strange feeling, I actually thought ants had managed to get in the house and were crawling on me.
I also have encroachment on my right side, at L-4, L-5. This causes lower back pain and numbness in my right leg, especially in the thigh, along with pain in my lower back. I’ve also experienced some strange feelings here, too, like water running down my leg.
In my case, the foraminal stenosis is caused by bony projections. What caused these to grow where they shouldn’t? No one knows for sure, but my doctors think it probably has to do with the weightlifting I used to do. Two doctors feel that the bony growth in my cervical spine could have been caused by carrying around “the twins” for all these years. It got so bad at one point that I considered having breast reduction surgery. I went to a seminar to learn more about the procedure, but when they got to the part about cutting off the nipples, I left.
Foraminal stenosis treatment
Foraminal stenosis treatment options are varied, depending on your doctor and your individual case. Decompression helps my neck. More specifically, I’ve had numerous Cox decompression therapies. That’s when your head is strapped onto a table and your spine is stretched. I call it “the rack.” This helps by opening up the foramina so that there’s more room for the nerves. I can do this at home now with an overhead traction device. So now, instead of having to endure “the rack,” I just hang myself when I need to!
Cox decompression helped my lower back pain a little, but it never lasted for long. When it’s acting up, the best relief I can get is to sit in my recliner in sort of a V shape. This opens up the lumbar spine some. Unfortunately, I can’t live the rest of my life in my recliner. That’s why I take full advantage of the days when I feel well. On really bad days, I can’t do anything.
Other foraminal stenosis treatments include massage and physical therapy. I've been through numerous sessions of both. The massage therapy often offers temporary relief, and it feels wonderful. Quite honestly, physical therapy didn't improve my condition, but it does help with some people.
I take Cymbalta for nerve pain, and I also take hydrocodone for pain. I don’t take the narcotic unless I absolutely have to, which isn’t every day. I DO NOT want to become addicted to pain-killers! When I’m in pain, I try other things first, before reaching for the hydrocodone. Aspirin is the first remedy I try, and stretching is usually the second. If that doesn’t help, I try heat. If I’m still hurting bad enough, I use my TENS unit. This is a little device I wear that shocks me, supposedly confusing the pain pathways to my brain, and it often works well for my lower back pain. If I’m still in significant pain, only then do I take the hydrocodone.
Another treatment for foraminal stenosis is a steroid injection directly into the affected area of the spine. I had this procedure done at a hospital. As I lay face-down, the anesthesiologist gave me an injection in the back with a small needle to deaden the area, then he used a longer needle to inject the steroid. My back was sore for about a day, but then it started feeling better. For almost three weeks, I had little pain in my lower back and leg. It was great! Unfortunately, it didn’t last for long. With some people, such an injection will bring relief for months, but for others, the effects might last only a week. I’ve also talked to a few people who received no benefit at all from the spinal injection. And it’s not like you can get one of these every few weeks. The doctors I know will only allow a patient to receive three such injections a year.
If nothing else works, you might consider surgery. Several doctors have told me, however, not to have back surgery unless I get to the point where I absolutely cannot walk. I’m not there, thank goodness! Open back surgery can be dangerous. Also, the recovery time is lengthy, as is the stay in the hospital. It can also cause long term side effects – not good ones.
Now there’s a newer procedure option for foraminal stenosis called a foraminotomy. With this procedure, the nerve pressure is relieved laparoscopically. The patient doesn’t have general anesthesia, which is always a safer route. A foraminotomy can be done with outpatient surgery, so you don’t even have to stay overnight in the hospital.
With a foraminotomy, a tube is inserted through a small incision, and slightly larger tubes are added. This creates an area large enough for the surgeon to work. A laser, a camera, and other instruments are inserted in to opening, without damaging tissue like muscles. The offending tissue or bone that’s compressing the nerve is removed, then the patient is stitched up with a couple of sutures. After an hour and a half or so in recovery, the patient can return home.
The foraminotomy sounds pretty good to me. I like the idea of its being minimally invasive, for one thing. For another, the recovery time is very fast, and I wouldn’t have to stay in the hospital. I’m going to talk with my doctor about this procedure on my next visit and find out where this can be performed. It could be that a foraminotomy is just the foraminal stenosis treatment I’ve been searching for!
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