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Treating Foraminal Stenosis in New Jersey

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stenosis anywhere in the body, is a narrowing of a hole through which tissue or bodily fluids pass. Foraminal stenosis is a spine condition characterized by a stenosis of the hole formed between interconnection vertebrae. This hole which exists on the superior and inferior side of each vertebrae is called the foramen. Some people develop a small amount of foraminal stenosis but never notice any symptoms. Others experience back pain and radiculopathy with moderate to severe foraminal stenosis. The level of pain along with other radicular symptoms, including weakness or loss of function, varies per person and per disease progression.

The medical staff, including pain management doctors, spine surgeons, exercise and rehabilitation specialists, and physical therapists, at Centers for Neurosurgery, Spine & Orthopedics (CNSO) in northern New Jersey has extensive experience in treating foraminal stenosis and other spine conditions. Learn more about what causes foraminal stenosis and how it is diagnosed and treated.

What Is Foraminal Stenosis?

The neural foramina are the openings along the spinal column where the nerve roots exit and branch out to other parts of the body. Over time, wear and tear on the spine, arthritis, and bone spur formation can narrow the space in the foramina. So can the forces caused by a car accident, sports injury, or fracture of the spine called spondylolysis. Foraminal stenosis can occur anywhere along the spine, but it is most common in the lower back (lumbar spine) and neck (cervical spine). It is commonly associated with radiculopathy symptoms, tingling, numbness, or pain that travels down an arm or leg. The location of this pain, along with patient history and a physical examination, allows the neurosurgeon or orthopedic spine surgeon to identify which level of the spine has foraminal stenosis.

Foraminal stenosis differs from spinal stenosis which is a narrowing of the central spinal canal in which the spinal cord exists. Foraminal stenosis specifically causes compression of the nerve root(s) on either side of the vertebrae, placing pressure on the nerve root. Consequently, the patient experiences pain or tingling on either the left or right side of their body. In the case of spinal stenosis, depending on the degree of central canal stenosis, patients have bilateral symptoms, called myelopathy, caused by the narrowing of the canal’s compression on the spinal cord. Myelopathic symptoms include loss of balance, frequent falling, and bilateral extremity weakness or loss of function.

Patients with minor symptoms often can be treated with conservative care such as over-the-counter medications, physical therapy, an epidural, or transforaminal injections. However moderate to severe foraminal stenosis can affect muscle control or even cause problems such as incontinence that can only be prevented by surgery. If these more severe symptoms are caught soon enough, they can be reversed by surgery.

What Causes Foraminal Stenosis?

Several different conditions can affect the space in the neural foramina. These include:

  • Osteoarthritis: This is a common degenerative condition that develops as the spinal vertebrae develop inflammation from wear and tear, resulting in the formation of bony deposits and bone spurs.
  • Herniated disc: This occurs when an intervertebral disc slips, because misshapen, or bulges into the foraminal space, pinching the spinal nerve rootsas they exit the spinal cord through the foramen.
  • Degenerative disc disease: Wear and tear on the intervertebral discs cause them to lose their water content, and become misshapen, weak, and capable of tearing. The lack of disc height causes the adjacent vertebrae to become closer, and thus can narrow the foramen which exists between vertebrae.
  • Congenital deformities: Spinal abnormalities that are present at birth cause narrowed foramina.
  • Spondylosis: Disc degeneration can lead to bone spurs or other issues that lead to chronic back or neck pain and radiculopathy.
  • Traumatic injury: Trauma to the spine caused by an event such as a car accident can affect the foramina.

Who Is at Risk for Foraminal Stenosis?

Foraminal stenosis is a very common condition – Cleveland Clinic reports that up to 40% of adults have foraminal stenosis in the lumbar spine by age 60. The risk of foraminal narrowing increases with age, so most patients who are diagnosed with foraminal stenosis are over the age of 50. Car accidents or injuries at younger ages expedite the progression. Women are at a higher risk of developing spinal stenosis than men are.

What Are the Signs and Symptoms of Foraminal Stenosis?

Some patients with mild foraminal stenosis seldom experience any symptoms. For others, symptoms can range from mild to severe. Signs of cervical foraminal stenosis include:

  • Neck pain, possibly radiating into one or both arms
  • Numbness and tingling in the arms, hands, and fingers
  • Weakness in the arms, hands, and fingers
  • Loss of grip strength and dexterity in one or both hands
  • Loss of balance, coordination, or bowel/bladder function

Symptoms of lumbar foraminal stenosis affect the lower back and limbs and can include:

  • Lower back and buttocks pain, possibly radiating into one or both legs
  • Numbness and tingling in the legs and feet
  • Weakness in one or both legs
  • Loss of grip strength and dexterity in one or both hands
  • Loss of balance, coordination, or bowel/bladder function

Foraminal stenosis symptoms can be associated with other spine conditions such as a herniated disc, spondylolisthesis, or degenerative disc disease. It is important to be evaluated by a neurosurgeon or orthopedic spine surgeon for accurate diagnosis, especially if a patient is experiencing any signs of weakness.

How Is Foraminal Stenosis Diagnosed?

To confirm a diagnosis of foraminal stenosis, the provider will review the patient’s medical history and conduct a physical examination to check for pain, loss of function, limited range of motion in the spine, or other symptoms. They may also use imaging tests, such as:

  • Magnetic resonance imaging (MRI)
  • Computed tomography (CT) scan
  • Electromyography (EMG)
  • Nerve conduction tests

The physician also will ask the patient about movements or positions that worsen or improve their symptoms.

Can Foraminal Stenosis Be Treated Without Surgery?

Foraminal stenosis often does not require back surgery. Many patients find relief with conservative treatments, such as:

  • Non-steroidal anti-inflammatory drugs (NSAIDs): These medications can reduce pain and inflammation caused by irritated nerves.
  • Physical therapy: Strengthening the muscles and ligaments around the spine can help mitigate symptoms of foraminal stenosis.
  • Epidural injections: An epidural steroid injectionuses X-ray guidance to deliver medication that reduces or eliminates inflammation around the foramina.
  • Transforaminal Injections: Using X-ray guidance, a pain management doctor injections steroidal mediation and local anesthetic within the foraminal space to minimize swelling and inflammation of the nerve root and surrounding area.
  • Antidepressants for chronic pain: Some antidepressants can be an effective pain-killing mechanism for chronic nerve pain.
  • Anti-seizure medications: Certain anti-seizure drugs may be used to reduce pain caused by nerve damage.

CNSO takes a conservative approach to treating foraminal stenosis by first minimizing inflammation that may be the main reason for the discomfort by utilizing pain management doctors and their specialized training. Only if they are unable to resolve the symptoms, or if the symptoms are too severe, does CNSO consider recommending surgery.

What Surgical Treatments Are Used to Treat Foraminal Stenosis?

If conservative treatments are not effective and symptoms are affecting the patient’s daily life, their neurosurgeon may recommend a surgical procedure to treat foraminal stenosis. Treatment options include:

Foraminotomy

In this procedure, a neurosurgeon or orthopedic spine surgeon removes the small portion of bone that is causing the narrowing of the foramina. This creates extra space in the opening where the nerve root exits the spinal canal, relieving the compression on the nerve root. A foraminotomy might need to be performed in combination with another procedure depending on the level of severity and areas of compression on the various nerve tissue.

Laminectomy

The laminae are the bony arches along the back of the spine. A laminectomy is a common surgical procedure in which a spine surgeon removes part or all of a lamina to release pressure on the spinal nerves and/or spinal cord itself.

Spinal Fusion Surgery

Fusion surgery may be recommended if a patient has extensively damaged vertebrae that need to be stabilized and strengthened. In this procedure, a spine surgeon removes the bone or intervertebral disc that is causing any compression on neural elements. Then, the surgeon uses a bone graft or synthetic implement to reconstruct the spinal column and stabilizes the structure to the adjacent vertebrae utilizing titanium to hold the bones in the correct position.

Spine surgery, as with all surgery, carries some degree of risk. However, many spinal decompression procedures are done utilizing minimally invasive techniques, resulting in less postoperative pain and shorter recovery times.

Recovering from Spinal Surgery

  • After spine surgery, a patient may be able to go home the same day or if it is a multi-spine level surgery, they may need to recover in the hospital for a day or two. Upon discharge from either a same-day surgical center or hospital, the neurosurgeon or orthopedic spine surgeon will provide instructions on the gradual return to daily living and exercising activities. Office employees usually can resume work within a day or two whereas manual laborers may need to take a few weeks off from lifting heavy objects. Most spine surgery recovery times are shortened and have improved outcomes with professionally guided physical therapy at CNSO as part of the rehabilitation plan.

    Depending on the patient’s prior conditioning, the CNSO medical team might need to recommend lifestyle changes to prevent future spine issues. These could include regular exercise, weight management, dietary recommendations, and an exercise plan. Maintaining a healthy weight and physical conditioning reduces stress on the spine.

Will Rehabilitation Involve Therapy?

Many patients see a physical therapist as part of their surgical recovery. A course of structured physical therapy usually includes exercises that improve a patient’s range of motion, mobility, and overall muscle strength. The physical therapist also may use manual therapy, manipulating the muscles and tissues to release muscle spasms, and trigger points to relieve pain. Typically, the therapist will give the patient a stretching and exercise regimen to continue at home after their series of appointments is complete.

What Kind of Follow-up Care Is Common After Foraminal Stenosis Treatment?

Recovery and follow-up care will vary depending on the surgical procedure, and each patient will have a personalized rehabilitation plan. The patient will have regular checkups as the incision site heals typically one to two weeks after the operation, then again in 3 months and 6 months. For the first 90 days after surgery, at CNSO, all postoperative related consultation visits are free. Any stitches are removed within two weeks following surgery. If the patient has surgery on the cervical spine, they may need to wear a surgical collar to hold the neck in the proper position as it heals. Follow-up appointments may include X-rays or other imaging tests if there was a fusion or hardware placement.

Can Future Spinal Stenosis Be Prevented?

While it may not be possible to prevent spinal stenosis, healthy habits may reduce a patient’s risk. These include:

Posture

Often, people do not notice how they sit or stand throughout the day. Holding the body in a neutral position, sitting in an ergonomic position, and maintaining a straight back helps reduce the risk of long-term spine issues.

Exercise

Regular physical activity is an important aspect of spine health. Exercise can improve flexibility, strengthen the muscles that support the back and spine, and help a patient maintain a healthy weight. A physiatrist or physical therapist can help a patient develop an appropriate exercise plan.

Avoid Repetitive Stress Injuries

Repeated twisting, bending, and lifting put stress on the spine. Patients with occupations that require these repetitive movements should make an effort to remain in top physical condition and potentially always wear protective gear and use proper lifting techniques.

Ergonomic Workspaces

Sitting at a desk all day can strain the cervical spine. A good ergonomic workstation helps a person maintain good posture and hold their body in a comfortable position. Ergonomic supports can include:

  • A chair that provides lumbar support
  • An adjustable-height desk
  • A monitor positioned at eye level to reduce neck strain

A properly designed workspace can reduce repetitive stress injuries such as carpal tunnel syndrome, as well.

Why Choose CNSO for Foraminal Stenosis or Spinal Stenosis Care?

As an award-winning comprehensive spine care center, CNSO treats all causes of foraminal stenosis or spinal stenosis. The medical team at CNSO includes neurosurgeons, orthopedic spine surgeons, physiatrists, and physical therapists who work together to form an individualized treatment plan for each patient. CNSO has locations in Bergen, Passaic, Essex, Morris, and Hudson counties, so patients throughout northern New Jersey can receive great care close to home.

Find Compassionate, Comprehensive Treatment at CNSO

Residents of northern New Jersey count on CNSO for comprehensive, patient-centered spine care. With conservative pain management strategies and innovative, minimally invasive surgical techniques, CNSO offers advanced care for patients with foraminal stenosis. For more information, contact us today.

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