Lumbar Foraminal Stenosis

The spine is made up of various structures, including the foramina. These openings in the vertebrae let nerve roots exit the spine and extend into other areas of the body. But, when they narrow due to age, injuries, or spinal conditions, it’s known as lumbar foraminal stenosis. 

In this article, we’ll discuss lumbar foraminal stenosis, what causes it, how it’s treated, and the complications it can trigger. 

Foraminal Stenosis: What Causes It and How It’s Treated

Foraminal stenosis can be caused by age-related spinal degeneration, spinal injuries, genetics, or other medical conditions. It’s typically treated with physical therapy, pain-relieving medication, epidural steroid injections, lifestyle modifications, bracing, and (if required) surgery. 

Causes of Foraminal Stenosis

Possible causes of foraminal stenosis include:

  • Age-related spinal degeneration

The spine changes with age. The spinal discs wear out, facet joints degenerate, ligaments thicken, and bone spurs can develop. These changes can narrow the foramina, leading to nerve compression. 

  • Spinal injuries

A spinal fracture, ruptured disc, or other spinal injury can compromise the foramina and may lead to foraminal stenosis.   

  • Genetics

Foraminal stenosis can exist at birth, as genetic factors can cause abnormally narrow foramina. This is known as congenital foraminal stenosis. 

  • Medical conditions

Certain medical conditions, including ankylosing spondylitis, degenerative disc disease, osteoarthritis, and Paget’s disease of bone can lead to foraminal stenosis. 

  • Ankylosing spondylitis is an autoimmune condition that leads to inflammation in the spinal ligaments and joints. Chronic inflammation can damage the spinal joints, causing them to fuse and narrow. This reduces the open space surrounding spinal nerves. 
  • Degenerative disc disease occurs when the spinal discs gradually break down, becoming thinner and weaker. Damaged discs can bulge into the foramina, causing stenosis. 
  • Osteoarthritis is a type of arthritis caused by wear and tear on the joints. When it affects the spine, it can lead to bone spurs that protrude into the foramina. 
  • Paget’s disease of bone is a chronic condition that causes your body to form abnormal bone tissue. The new bone is weak and irregularly shaped. If it forms in the spine, it can narrow the foramina. 

Treatments for Foraminal Stenosis

Common treatments for foraminal stenosis include:

  • Physical therapy

Physical therapy is natural, drug-free, and provides sustainable solutions to improve foraminal stenosis back pain. So, it’s often used as the first line of defense against this spinal condition. Your physical therapist may recommend strengthening exercises, stretches, and alternative therapies (like electrical stimulation, dry needling, and massage) to reduce pain, improve muscular support for the spine, and stimulate healing. 

  • Medication

When lumbar foraminal stenosis pain makes it difficult to get through your day, your doctor may suggest pain-relieving medication. While not a long-term solution, painkillers can help you cope with the condition while other treatments help heal the damaged tissue. Your doctor will likely recommend starting with over-the-counter pain medication, only advancing to prescription formulations if absolutely necessary. 

  • Epidural steroid injections

Epidural steroid injections involve injecting steroid medication into the epidural space (the area surrounding the spinal nerves). Steroid medication brings down inflammation by dampening the immune response. This can reduce pain and swelling associated with foraminal stenosis, although it’s important to receive no more than four injections per year to prevent tissue atrophy. 

  • Lifestyle modifications

Adjusting your lifestyle to prioritize health and healing can complement your foraminal stenosis treatment plan. Examples include reaching a healthy weight, eating a nutritious diet, participating in low-impact exercise, improving your posture, and quitting smoking. Your doctor can recommend additional modifications according to your current lifestyle and unique needs. 

  • Surgery 

When non-surgical treatments fail to improve foraminal stenosis, back surgery may be the only remaining option. Rest assured, surgery is only recommended after six to 12 months of failed non-surgical therapies, and only if spinal pain is compromising your quality of life. Foraminotomy, laminectomy, and discectomy are the most common surgical procedures for foraminal stenosis. 

Can Foraminal Stenosis Be Treated Without Surgery?

Yes, foraminal stenosis can be treated without surgery. In fact, most patients don’t need surgery for foraminal stenosis, as it can be effectively managed with conservative methods. 

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With that said, surgery may be recommended for foraminal stenosis if:

  • Conservative methods fail to provide results after several months. 
  • Your pain is making it difficult to complete your daily activities. 
  • Your pain is compromising your quality of life and mental health. 
  • The nerve compression is severe, putting you at risk of nerve death. 
  • You’re experiencing red flag symptoms, including:
    • Loss of bowel or bladder control
    • Severe muscle weakness 
    • Loss of muscle control
    • Balance or coordination problems

Can Foraminal Stenosis Paralyze You?

Yes, foraminal stenosis can paralyze you, but typically only if it’s left untreated for a prolonged period. 

With prompt treatment, foraminal stenosis is unlikely to cause paralysis, and your doctor will work to limit the nerve compression and bring down inflammation. However, if you experience warning signs of paralysis, seek emergency medical care. These include:

  • Severe weakness in one or both legs
  • Loss of bowel or bladder control
  • Severe numbness or tingling in the legs
  • Balance and coordination problems

Severe Bilateral Foraminal Stenosis

Severe bilateral foraminal stenosis occurs when foramina on both sides of the spine narrows, causing nerve compression on both sides of the spine. This can lead to pain, tingling, numbness, and weakness that radiate into the left and right extremities. 

For context, unilateral foraminal stenosis is the other form of this condition, and it occurs when the foramina on only one side of the spine narrow. This typically causes radiating symptoms on just one side of the body. 

Severe bilateral foraminal stenosis causes more pronounced, disruptive symptoms than mild stenosis. Your pain may be so severe that it’s difficult to participate in daily activities. Other symptoms include:

  • Difficulty standing and walking
  • Burning, tingling, and weakness in both sides of the body
  • Muscle weakness in the extremities
  • Severe paraesthesia (pins and needles sensation) in both sides of the body
  • Difficulty balancing 

If you experience symptoms of foraminal stenosis, whether mild or severe, see your doctor for an evaluation. The sooner you start treatment, the more effectively you can prevent worsening pain.