Neural foraminal stenosis, or neural foraminal narrowing, is a type of spinal stenosis. It occurs when the small openings between the bones in your spine, called the neural foramina, narrow or tighten. The nerve roots that exit the spinal column through the neural foramina may become compressed, leading to pain, numbness, or weakness.
For some people, the condition doesn’t cause any symptoms and doesn’t require treatment. However, severe cases of neural foraminal stenosis can cause paralysis.
If symptoms do occur, they typically happen on the side of the body where the nerve root becomes pinched. In left neural foraminal stenosis, for example, the symptoms will typically be felt in the left side of the neck, arm, back, or leg.
When both sides of the foraminal canal narrow, it’s referred to as bilateral neural foraminal stenosis.
What are the symptoms?
Mild cases of neural foraminal stenosis usually don’t result in any symptoms at all. If the neural foramen narrows enough for a nerve root to become compressed, it can lead to:
- back or neck pain
- numbness or weakness of the hand, arm, foot or leg
- shooting pain going down the arm
- sciatica, a shooting pain that travels from your lower back through your buttocks and into your leg
- weakness of the arm, hand, or the leg
- problems with walking and balance
The symptoms will usually start gradually and get worse over time. They can happen on one side or on both sides of the spine. Symptoms may also vary depending on which part of the spine narrows and pinches a nerve:
- Cervical stenosis occurs in the neural foramens of the neck.
- Thoracic stenosis occurs in the upper portion of the back.
- Lumbar stenosis develops in the neural foramina of the lower back.
What are the causes?
Neural foraminal stenosis occurs when something narrows the spaces between the bones of your spine. The risk of neural foraminal stenosis increases with age. This is because normal wear and tear associated with aging can lead to narrowing. As we age, disks in the spine lose height, begin to dry out, and start to bulge.
In younger individuals, injuries and underlying conditions can also result in the condition.
Causes of neural foraminal stenosis include:
- bone spurs from degenerative conditions, like osteoarthritis
- being born with a narrow spine
- a skeletal disease, such as Paget’s disease of the bone
- a bulging (herniated) disk
- thickened ligaments near the spine
- trauma or injury
- scoliosis, or an abnormal curve of the spine
- dwarfism, such as achondroplasia
- tumors (rare)
How is it treated?
Treatment for neural foraminal stenosis depends on the severity of the condition. If your symptoms are mild, your doctor may recommend simply monitoring your condition to make sure it doesn’t get any worse. You may want to rest for a few days.
If your symptoms are bothersome, your doctor might recommend that you treat them with medications or physical therapy.
Some medications that can help treat the symptoms of neural foraminal stenosis include:
- over-the-counter pain relievers such as ibuprofen (Motrin IB, Advil), naproxen (Aleve), or acetaminophen (Tylenol)
- prescription pain relievers, like oxycodone (Roxicodone, Oxaydo) or hydrocodone (Vicodin)
- anti-seizure medications that help relieve nerve pain, such as gabapentin (Neurontin) and pregabalin (Lyrica)
- corticosteroid injections to reduce inflammation
Physical therapy can also help strengthen the surrounding muscles, improve your range of motion, stretch out the spine, and correct your posture. For cervical stenosis, your doctor may advise you to wear a brace called a cervical collar. This soft, padded ring allows the muscles in your neck to rest and decreases pinching of the nerve roots in your neck.
If your symptoms are severe, surgery may be necessary so that your doctor can widen the neural foramen that is compressing your nerve. This surgery is minimally invasive and typically performed through an endoscope. Only a very small incision is needed by the surgeon. The procedure may include:
- laminotomy or laminectomy, which is removal of the bone spurs, scars, or ligament causing the narrowing
- foraminotomy, or enlarging the foramina
- laminoforaminotomy, which involves both of these methods
For herniated disks, your doctor might perform surgery to remove the disk.
Are there any complications?
Though not common, untreated neural foraminal stenosis can lead to:
- permanent weakness
- urinary incontinence (when you lose control of your bladder)
When to see a doctor
You should see your doctor if you experience pain or numbness radiating down your arm or leg that doesn’t go away in a few days. Seek immediate medical attention if any of the following occurs:
- The pain comes after a severe injury or accident.
- The pain suddenly becomes severe.
- You can’t control your bladder or bowels.
- Any part of your body becomes weak or paralyzed.
Outlook for neural foraminal stenosis
Most cases of neural foraminal stenosis improve on their own or with conservative at-home treatments, like painkillers, gentle yoga, and physical therapy. Surgery isn’t usually necessary, but it is considered a definitive solution for a case of neural foraminal stenosis.
After surgery, most people are able to get back to day-to-day life within just a couple days, but may need to avoid heavy lifting for a few months.
Though foraminal surgeries are often very successful, problems with the spine are still possible in the future.