What Is Foraminal Stenosis?

By Chris Centeno, MD /

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What is foraminal stenosis?  Is it necessarily the cause of your back or neck pain, and does foraminal stenosis require surgery?  Let’s start from the beginning…

Your spinal column, or backbone, is made up of vertebrae, stacked one on top of the other, with a disc between each level to provide cushion and absorb shock. The spinal canal is a tunnel that runs down the column and houses the spinal cord, which has many nerves that transmit muscle commands and take sensory information to the brain. The spinal column also has small holes where the nerves exit, and branch off to other parts of the body. There is one at each level. One hole is called a foramen. The plural is called foramina. Watch the short video above for clear images of what these structures look like.

The foramen is shaped like a tunnel that exits off of the spinal canal, and the spinal nerves for each specific level traverse, or go through, them. When the spine is healthy, these nerves easily traverse the tunnel, properly transmitting sensory information from each part of the body to the brain. When the spine is not healthy, however, this flow of information can be disrupted. This can happen when there is foraminal stenosis.

What Is Foraminal Stenosis?

The disc, that cushion between the spine bones, can bulge, or the spine joints can get arthritis, causing the foramen to narrow. This neural foraminal narrowing is called foraminal stenosis, and this can cause the nerves to get pinched. The pressure from a pinched nerve can cause muscle tightness, weakness, numbness, tingling, or pain in the specific distribution of that nerve. So, for instance, if there is foraminal stenosis in the level of the lumbar spine where the nerves branch into your leg and down to your toes, you could experience numbness (or one of the other sensations mentioned) all the way down in your big toe. Tingling in your fingers or tightness in the biceps muscle, for example, could be from foraminal stenosis in the level of the cervical spine where the nerves branch into your arm muscles and fingers.

What Are The Symptoms of Foraminal Stenosis?

  • Lumbar Stenosis: Muscle tightness, weakness, numbness, tingling, or pain in the leg, buttocks, or feet.
  • Cervical Stenosis: Muscle tightness, weakness, numbness, tingling, or pain in the neck, shoulders, arms, or hands.
  • Thoracic Stenosis: Muscle tightness, weakness, numbness, tingling, or pain in the upper back or front of your body.

The pain and discomfort can worsen if you sneeze or cough, which can be an indicator that you have this condition.

Foraminal Stenosis, or neural foraminal narrowing, can be diagnosed through:

  • a physical examination of your level of pain, reflexes, movement, and muscle strength
  • a symptom assessment of whether your symptom matches the symptoms associated with foraminal stenosis
  • diagnostic imaging X-rays, MRI scans, CT scans, and tests of nerve conduction to see if the space between your bones has narrowed

What Is The Treatment for Foraminal Stenosis

Surgery can open up the hole, but surgery can have major side effects and can have serious implications. A spinal fusion is often added when surgically treating stenosis, but the mention of a fusion should be your red flag to seek other opinions. Why? Adjacent segment disease (ASD) can happen, which means that the levels above and below the fusion can get damaged over time. To learn more, see the video.

Additionally, surgery is often performed after diagnosing the problem solely based on findings on an MRI. I’ve shared research before showing that an MRI indicating stenosis isn’t enough to appropriately diagnose that stenosis as the cause of back pain, and because of this, if you have a foraminal stenosis, you really shouldn’t put all your trust in an MRI. Patients may or may not have back pain with a foraminal stenosis, though they may have pain in another location, such as the knee or shoulder. Research also shows that physical therapy is as effective as surgery in relieving stenosis, so why take the risk with surgery? You would not want to undergo something as invasive as surgery if there are less invasive alternatives. Regenexx’s platelet treatments are a less invasive alternative to consider for treating foraminal stenosis that use your own body’s natural healing agents.

I Have Foraminal Stenosis

About two years ago, I began to notice a little numbness in my right thumb. I then woke up one morning and felt a knifelike pain in my left shoulder blade. I was convinced that I had a shoulder problem and had one of my partners inject PRP into that area, which did no good. Also, my left biceps and forearm would cramp and hurt, and when I traveled on planes, my left shoulder would get weak and then recover. I finally got a neck MRI because my neck was stiff. Sure enough, I had foraminal stenosis. What I didn’t do next is important. I didn’t see a spine surgeon. Instead, I had Dr. Schultz at our Colorado office inject our high-dose platelet lysate into the foramen and around the nerve. It took a few injections, but within a week or two, we had the problem managed. I now get periodic injections a few times a year to keep this under control. I can work out at a high level, so I’m fully functional.

To learn more about nonsurgical foraminal stenosis treatment options, see below:

The upshot? What is foraminal stenosis? It’s a narrowing of the tunnel where the spinal nerve exits, and it causes symptoms in areas of the body controlled by those spinal nerves. However, foraminal stenosis seen on MRI doesn’t automatically mean the stenosis is the cause of your back or neck pain. However, whether it is causing back pain or referring pain, tingling, or weakness somewhere else, it’s a good idea to explore nonsurgical regenerative medicine solutions to treat it before it progresses.

Is Foraminal Stenosis the Same as Spinal Stenosis?

Foraminal stenosis is the narrowing of the opening at the sides of the vertebrae where each spinal nerve exits the spinal canal and goes out into an area of the body. Spinal stenosis is the narrowing of the central spinal canal itself where all the spinal nerves run through. Both foraminal stenosis and spinal stenosis can occur due to herniated discs, degenerative discs, or facet arthritis.

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8 thoughts on “What Is Foraminal Stenosis?

  1. Mark Jordan

    My son is 26, he has 2 degenerative discs stacked on top of each other. They are the first and second vertebrae in your pelvis. They show up dark on a MRI while the rest light up. he has had both cold and hot re-sodomy’s which have provided relief but only for 6-8 months before the nerves grow back. So my question is can your stem cell regenexx treatment actually help rebuild the disc to heathy?

    1. Regenexx Team Post author

      Mark,

      It is a misnomer that degenerated discs can be “rebuilt”. However, in our experience degenerated discs respond well to a treatment protocol focused on platelet and/or stem cell technology deployed to treat sloppy disc movement due to lax ligaments and arthritic facet joints. Please see: http://www.regenexx.com/stem-cells-disc-regeneration/

  2. Glenn Waldron

    It is great you are able to get an injection of stem cells anytime you need it. Good for you! However, the rest of us have to pay out of pocket, for a very expensive procedure. It is most doubtful that insurance or Medicare will ever participate in coverage, with direction it is going. When is it (procedure) going to become affordable option for the rest of us?

    1. Regenexx Team Post author

      Glenn,
      There are likely going to be significant changes with the way Health Insurance works in the near future. We can hope that those changes will cover regenerative procedures which are much less expensive, and better for the patient, than surgery.

  3. stef

    Treating the nerve does not make the narrowing stop. Is there a moment where it close completely ? Also you always speak about underlying forces that must be adressed. Why is there bone build up to begin with ? Since you don’t speak about it, means you don’t know or you don’t have a solution ?

    1. Regenexx Team Post author

      Stef,
      Narrowing of the foraminal space does not just “happen”. Bone is alive and reacts to it’s environment. One of the forces it reacts to is instability by making more bone to “shore up” the joint. In a hip for instance this would be CAM or Pincer “impingement”. In vertebrae, the additional bone can cause narrowing or stenosis. Another force that the bone can react to is when the cushioning disc wears out, the bone underneath the disc makes itself thicker to handle the new forces. So in addition to treating the nerve, we treat the the cause of the resulting instability by focusing treatment on the lax ligaments and facet joints. Please see: http://www.regenexx.com/blog/stem-cell-disc-treatment/

  4. christine schimmel

    hi chris i have DDD on C123 4 minor Herniated discs in the neck and bulging disc on c5 and c6 c7 fully herniated i also have foraminal narrowing on c123 and c 67 will the platet lystate help along with prp treaments

    1. Regenexx Team

      Hi Christine,
      Likely, that would be our DDD procedure. Please see: https://regenexx.com/resources/videos/treating-ddd-and-lumbar-stenosis-with-platelets-and-stem-cells/ To see if you would be a Candidate, please click on “Get Started” here: https://regenexx.com/conditions-treated/spine/​spinal-stenosis/ or give us a call at 855 622 7838.

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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