Mustering Up the Nerves: Addressing the Pain of Foraminal Spinal Stenosis

Senior elderly man with backache isolated on gray background. Health care patient concept

Sometimes a pain in the neck – or the back, for that matter – doesn’t stop there. “If patients start to experience symptoms in other parts of their bodies, it raises the possibility of foraminal stenosis,” notes Kaixuan Liu, MD, PhD, a world renown endoscopic spine surgeon and president of New York/New Jersey-based Atlantic Spine Center, “a potentially serious spine condition that requires medical attention.”

“Stenosis” refers to narrowing. When it occurs within our spine, it can create big problems for our central nervous system – and, of course, the rest of our body.

“The human spine is really a feat of biological engineering,” Dr. Liu observes. “Not only does it provide support and flexibility, it also houses the nerves that carry messages from our brain to the rest of our body.”

“For those messages to reach their final destinations,” Dr. Liu explains, “our nerves need unimpeded passage, first through the spinal column and then out to the intended body part. The exits leading out from our spine are called the foramen. These tiny archways allow our nerves to make the connection between our brain and our body.”

Most of us start off with wide-open foraminal passages. But as we age, these “out” doorways may gradually narrow. “Disc degeneration, bone spurs, arthritis,” lists Dr. Liu. “There are a number of conditions that can start to close up the foramen, eventually putting pressure on the exiting nerves and causing symptoms that show up beyond the spine.”

“If the foramen of the upper spine are narrowed,” Dr. Liu continues, “patients may experience symptoms in their upper body – for example, pain, weakness or tingling in their arms – as well as problems with balance. If nerves exiting lower-spine foramen are disrupted, the lower body will be affected. Sciatica, for example, can result.”

While the National Institute of Neurological Disorders and Stroke (NINDS) advises that back pain is often temporary, spinal stenosis – whether of the spinal column or specific to the foraminal passages – stands apart as a potentially worsening condition that can result in permanent nerve damage. 

Underscoring its severity, NINDS-supported research shows that spinal stenosis is one of the few back conditions that may benefit from surgery.

Dr. Liu emphasizes that suspected spinal stenosis requires a medical evaluation. He suggests patients consider the following:     

6 Questions to Ask About Foraminal Stenosis 

1. When should I worry about foraminal stenosis? “Patients with numbness, weakness, pain, or tingling extending to their upper or lower extremities – sometimes called ‘radiculopathy’ – or balance problems need to be evaluated,” states Dr. Liu. 

2. What tests should I have? “We need to identify where nerves are being affected,” Dr. Liu explains. “X-rays are limited, so other images, for example MRIs, CAT scans and myelograms, may be needed. Nerve signal tests – such as electromyography (EMG) – may also help.”

3. How do I know if I need surgery? “Extreme cases affecting the bowels, bladder or ability to walk may require immediate surgery,” Dr. Liu notes. “Otherwise, it’s vital for the patient to collaborate with his or her doctor. It can help to start with non-surgical approaches: Liues in lifestyle or therapies to alleviate nerve pressure. However, if pain and disability persist or worsen, patients may choose surgery.” 

4. What kind of surgery works best? “The procedure to widen the foraminal passages is called a foraminotomy,” says Dr. Liu. “We can now do this endoscopically, with very good results. Patients can be back on their feet and at home the same day.” 

5. What is my prognosis? “Surgery can significantly improve pain and disability,” Dr. Liu observes. “Research shows this bump is even greater when patients are involved in educating themselves and collaborating with their doctor regarding treatment – referred to as ‘shared decision making.’”

6. What can I do to prevent it? “Spinal stenosis is often a by-product of aging,” acknowledges Dr. Liu. “That said, exercise, a healthy diet, and informed choices regarding ergonomic furniture and footwear can help ward off spinal degeneration.”   

To prevent long-term problems, Dr. Liu reinforces the importance of early action: “Spinal stenosis should not be ignored.”

Kaixuan Liu, MD, PhD, is a board-certified physician who is fellowship-trained in minimally invasive spine surgery at Atlantic Spine Center. 

Atlantic Spine Center is a nationally recognized leader for endoscopic spine surgery with several locations in NJ and NYC.

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