Foraminal Stenosis

What is foraminal stenosis?

Foraminal stenosis is narrowing that happens in certain places around the nerves that come out of your spinal cord. It’s a type of spinal stenosis that affects the neural foramen, a series of openings on both sides of your spine.

Foraminal stenosis is like what happens to an electrical cord when you shut a door on it, wedging it between the door and frame. Eventually, the pressure on the cord can damage it, affecting how it conducts electricity. Likewise, foraminal stenosis can put pressure on affected nerves. Eventually, that can affect signals traveling through the nerve and cause nerve pain, and sometimes, permanent nerve damage.

Types of this condition

A neural foramen is an opening where a spinal nerve exits your spine and branches out to other parts of your body. The size of the opening depends on where it is in your spine. The location of the foraminal stenosis also determines what type you have.

The different sections of your spine, from top to bottom, are as follows:

• Cervical spine (neck). This is the second most common area for foraminal stenosis to develop.
• Thoracic spine (upper and middle back).
• Lumbar spine (lower back). This is the most common area where foraminal stenosis happens.
• Sacral spine (far lower back and pelvis).
• Coccygeal spine (tailbone; pronounced “cah-kij-ee-ul”).

How common is this condition?

Data on how often foraminal stenosis happens is limited. It seems to be common, especially in people over age 55, and more likely to happen as people age.

Some studies indicate up to 40% of people have at least moderate foraminal stenosis in their lumbar spine by age 60. That increases to about 75% in people aged 80 and older.

However, most people with foraminal stenosis don’t know they have it, even when it’s severe. Only 17.5% of people with severe foraminal stenosis have symptoms.

What are the symptoms of foraminal stenosis?

Foraminal stenosis symptoms are similar to those of a pinched nerve or another form of radiculopathy.

Possible symptoms, listed from least to most severe, can include one or more of these:

• Pain.
• Paresthesia (tingling or a “pins and needles” sensation).
• Numbness.
• Muscle weakness or loss of muscle control.

Symptom location

The location of your symptoms is a key clue for diagnosing and treating foraminal stenosis. That’s because of the structure of your spinal cord and the spinal nerves that branch off it.

Your spinal cord is like a freeway, and your spinal nerves are entry and exit ramps. Nerve signals traveling to and from your brain have to use the correct ramp to reach their destination. When you have symptoms in a certain place, your provider can use the affected dermatome (area of your skin directly connected to the spinal nerve) to figure out — or at least, narrow down — where the issue is.

Some examples of symptom location and how they relate to the location of the narrowing are:

Symptom situations and timing

When your symptoms happen is also a potential clue your healthcare provider might need. What you’re doing when you have symptoms can change whether or not the symptoms happen.

An example of this is lumbar foraminal stenosis. It tends to happen or get worse when you’re standing up and gets better when you sit down. Keeping track of your symptoms (such as writing down details of the symptoms when they happen) can help your provider diagnose and treat your condition.

What causes foraminal stenosis?

There are many causes and contributing risk factors that can lead to foraminal stenosis. Some people can develop it with only one of these. For others, it can be a combination of more than one. Risk factors and possible causes include:

• Injuries. Back injuries can cause scar tissue or structural changes that cause or contribute to foraminal stenosis. Some examples include herniated or bulging disks or spine fractures.
• Aging. Bones and connective tissues around your spine wear out naturally as you age. That can make it easier for foraminal stenosis to develop.
• Musculoskeletal or inflammatory conditions. Diseases that affect your muscles, bones or connective tissues that hold your spine together can cause foraminal stenosis. Conditions like degenerative disk disease, ankylosing spondylitis or Paget’s disease of the bone are examples.
• Spine surgery. Surgical procedures can contribute to developing foraminal stenosis. Persistent spinal pain syndrome (PSPS), a condition that can follow unsuccessful surgeries to treat back pain, is a possible cause of foraminal stenosis.
• Growths or tumors. Cysts and tumors (including cancerous and benign growths) can crowd the spinal cord and spinal nerves. That can cause foraminal stenosis to happen where it wouldn’t ordinarily occur. Bone spurs (osteophytes) can also cause this condition.
• The natural structure of your spine. The spinal canal is the space inside your spine that holds your spinal cord. It naturally gets narrower farther down your back. That’s part of why lumbar foraminal stenosis is the most common type.
• Anatomy differences. Some people have a spinal structure that makes it easier for foraminal stenosis to develop. This doesn’t have to be a sign of a medical condition. It’s simply a difference that may happen to some people. Scoliosis (curving of the spine) can also contribute.

What are the complications of this condition?

Complications of foraminal stenosis aren’t common, and serious complications are even rarer. When complications do happen, they can disrupt your life and routine activities. Some are serious and will need treatment to keep them from getting worse and causing other issues.

Some of the possible complications include:

• Chronic pain.
• Specific nerve pain conditions like sciatica.
• Nerve damage.
• Weakness or paralysis of muscles connected to the affected nerve root.
• Urinary and bowel incontinence because of pressure on nerves that help you control your bladder and bowels.
• Pain-related mental health issues like anxiety and depression.
• Pain that limits flexibility and mobility enough to keep you from being physically active or living independently.

How is foraminal stenosis diagnosed?

A healthcare provider can diagnose foraminal stenosis based on your symptoms. They can also use magnetic resonance imaging (MRI) to confirm their diagnosis. An MRI shows highly detailed images, allowing a healthcare provider to tell apart bones, nerves and muscles.

Many people don’t have symptoms even though they have foraminal stenosis that’s visible on MRI. That means an MRI is useful but not always necessary.

For people who can’t undergo an MRI, combining a computed tomography (CT) scan with a myelogram is usually the best option. This is especially helpful for people with implanted devices like pacemakers.

Other diagnostic tests that look for nerve-related problems may also help. Electromyography (EMG) and nerve conduction studies are examples of other common tests.

You might need other tests depending on your specific health history or needs. Your healthcare provider is the best person to tell you what other tests they recommend and why.

How is foraminal stenosis treated, and is it curable?

Foraminal stenosis may be treatable, and for some people, it’s possible to correct it. There are several treatment options. Some options may not be available to you, depending on your health history, the cause(s) of your foraminal stenosis and other factors. Your healthcare provider is the best person to tell you what treatment options are possible and which they recommend.

As long as you’re symptom-free, you probably don’t need treatment. Early symptoms like pain are often a reason to consider conservative treatments. Having complications like incontinence, weakness or paralysis is usually a sign that you need interventional treatments or surgery.

Treatments tend to come in three main types:

Conservative treatments

Conservative treatments are almost always the first approach with foraminal stenosis. They generally involve oral medications, changes to your activity and other noninvasive approaches.

• Relative rest. Reducing movement can help with stenosis, especially when it happens with inflammation and swelling from an injury. However, total rest (including bed rest) isn’t usually helpful.
• Physical therapy. This treatment approach can help you improve physical strength and flexibility, reducing the effect of foraminal stenosis symptoms.
• Oral anti-inflammatory medications. Nonsteroidal anti-inflammatory drugs (NSAIDs) can sometimes reduce the inflammation around the affected spinal nerve. That may relieve foraminal stenosis symptoms.
• Oral steroid medications. These can reduce inflammation and swelling around the area of concern.
• Oral opioid medications. These help treat acute pain, but are usually for short-term use only. That’s because of the risk of developing opioid use disorder or opioid-induced pain disorders.

Interventional treatments

Interventional treatments are a step up from conservative treatments. Injections of medications — like steroids — directly around the affected spinal nerve can sometimes help. These involve X-ray guidance to make sure the injection reaches the right spot. These injections may even delay your need for more direct treatments.

Surgical treatments

Most modern spinal decompression surgeries involve a minimally invasive approach. That means they use smaller cuts (incisions), reducing bleeding, pain and recovery time. Some of the possible surgeries include:

• Foramen surgery. A foraminotomy is a surgery to widen the neural foramen. Foraminectomy is similar but also involves removing tissue from the surrounding area to widen the foramen.
• Facet joint surgery. This typically involves facetectomy, removing an entire facet joint to relieve pressure on your spinal cord and spinal nerves.
• Lamina surgery. Laminotomy involves removing a small section of bone and soft tissue from a vertebra that’s crowding or pressing on your spinal cord or spinal nerves. Laminectomy is removing a larger center section of the vertebra.
• Bone spur removal. Removing bone spurs (osteophytes) can relieve pressure if they’re pressing on one or more spinal nerves.
• Spinal cord stimulator. This involves implanting an electrical stimulator that connects to part of your spinal cord. The stimulator sends a mild electrical current to cells in your spinal cord. The current occupies the cells, keeping them from sending and relaying pain signals. A spinal cord stimulator can help if surgery doesn’t work or isn’t possible.

Complications/side effects of the treatments

Because there are different types of treatment, the complications and side effects can vary greatly. Likewise, recovery time and what to expect after treatment can also differ from person to person. Your healthcare provider is the best person to tell you about possible or likely side effects that you may experience and what you should expect during your recovery.

Can I lower my risk of foraminal stenosis or prevent it entirely?

Foraminal stenosis happens unpredictably, and even when it happens, it may not cause any symptoms. Because of this, there’s no way to prevent it or reduce the risk of it happening.

What can I expect if I have foraminal stenosis?

Foraminal stenosis is a condition that can happen without symptoms. Some people learn they have it because it appears on an imaging scan they get for another reason. Others never know they have it.

Back pain may start before the nerve symptoms of foraminal stenosis. If you have back pain that lasts more than a few weeks, you should talk to a healthcare provider. They can help determine if your pain is foraminal stenosis or refer you to a specialist who can investigate further.

If you have more severe symptoms like tingling, numbness or muscle weakness — especially when these affect your arms or legs — you should make an appointment to see a healthcare provider as soon as possible. Foraminal stenosis severe enough to cause these symptoms can cause nerve damage and more serious complications.

How long does foraminal stenosis last?

Foraminal stenosis can be temporary or it can be longer-lasting. It’s most likely to be temporary when it happens because of short-term swelling and inflammation, such as from a minor injury that will heal on its own.

Foraminal stenosis is likely to be permanent when it happens with a chronic condition. It’s also likely to be permanent if it happens after a medical procedure or if it’s partly due to your spine’s natural shape and structure.

What’s the outlook for foraminal stenosis?

Most cases of foraminal stenosis never cause symptoms. Even severe stenosis only causes symptoms in about 17.5% of people. As long as you don’t have any symptoms of this condition, there’s little or no cause for concern (your healthcare provider can tell you which is true for you specifically).

When foraminal stenosis causes symptoms, the outlook can still vary. Minor symptoms may respond well to treatment and stop. Some people may have symptoms that worsen slower, thanks to treatment.

When foraminal stenosis becomes severe enough, it usually needs more direct treatments (such as surgery or catheter-based procedures). That’s usually to prevent foraminal stenosis from worsening and/or causing permanent nerve damage or other complications.

How do I take care of myself if I have foraminal stenosis?

If you have foraminal stenosis, you usually won’t need to make any changes or do anything different unless you start to experience symptoms.

If you have back pain, you can try to manage it yourself initially. However, you should see your healthcare provider if you still have it after a few weeks.

• NOTE: Pain is a symptom you shouldn’t ignore or try to self-treat if it lasts more than a few weeks. Over time, chronic pain can change the way your body and brain process pain signals, causing conditions like central pain syndrome.

If your healthcare provider diagnoses you with foraminal stenosis, they can guide you on what you can do to care for yourself. They can also offer support and information to help you choose possible treatment options.

When should I go to the ER?

You should go to the nearest ER if you have sudden severe back pain, especially with an injury, or if you suddenly develop symptoms that could signal an issue with your spinal cord or spinal nerves. Those symptoms include the sudden appearance of:

• Muscle weakness in one or both legs.
• Incontinence that causes you to pee (urinate) or poop (defecate) when you don’t intend to.
• Pain that keeps you from going about your usual activities.

How serious is foraminal stenosis?

Foraminal stenosis isn’t usually serious. Most people don’t even know they have it because they don’t have symptoms. It’s only serious if it involves pressure on your spinal nerve that’s severe enough to cause muscle weakness, tingling or numbness.

What’s the difference between spinal stenosis and foraminal stenosis?

Foraminal stenosis is a type of spinal stenosis affecting a specific area of your spine. It affects a neural foramen (or more than one), an opening where a spinal nerve exits your spine to branch out into your body. Spinal stenosis refers to narrowing in any part of your spine, not just a neural foramen. It’s also possible to have both at the same time.

What’s the best treatment for foraminal stenosis?

The best treatment for foraminal stenosis can vary from person to person. Treatments that help one person might not be as helpful for others. Your healthcare provider is the best person to tell you about possible treatments, especially those likely to help you most and align with your goals and needs.

A note from Cleveland Clinic

Most people who have foraminal stenosis don’t know they have it. That’s because most cases don’t cause symptoms. When it does cause symptoms, foraminal stenosis can range from mildly inconvenient to severely disruptive, causing pain and nerve problems that can affect your daily routine and activities. Fortunately, severe cases aren’t common, and there are multiple ways to treat it.

If you suspect you have foraminal stenosis, talking to a healthcare provider is a good idea. Pain and nerve-related issues are often easier to treat early on. That can help you avoid more severe symptoms or complications. And that way, foraminal stenosis is less likely to restrict your life and hold you back from doing things you enjoy.