Stenosis is a medical condition where an area of the spine narrows — usually in the neck or lower back. This can compress the spinal cord or nerves. Based on the specific nerves affected, spinal stenosis may create pain or numbness in the neck, back, shoulders, arms or legs.
There are various types of problems that can reduce the amount of space inside the spinal canal. The possible causes can range from birth defects to cancerous tumors, but age-related degeneration is the most common cause of foraminal stenosis.
- Disc Degeneration. As a person ages, the cushions that separate vertebrae flatten and spread. As time goes by, the hard, fibrous outer shell of the disc could develop tiny tears. This will cause the jelly-like material in the disc’s center to leak and press on your spinal cord and nerve roots. Chiropractic care and Spinal Decompression Therapy can both help elongate the spine and restore normal motion in the joints thereby alleviating the symptoms of this condition and eliminating the need found necessary drugs or surgery.
- Osteoarthritis. Just like the discs above, the facet joints between the vertebrae in a person’s spine can deteriorate. The body will attempt to heal itself. Bony growths called ‘bone spurs’ are usually a by-product of this. These spurs may narrow the spinal passages. The beginning of this condition could be known as Foraminal Stenosis, Facet Imbrication or Facet Syndrome. Just like above, chiropractic care and Spinal Decompression Therapy can help elongate the spine and restore normal motion in the joints and assist in the symptoms of this condition, alleviating the need for unnecessary drugs or surgery.
- Thickened Ligaments. Ligaments are made of a tough, fibrous material that assists in holding a person’s bones together. They may stiffen and thicken over time. This thickening can also narrow the spinal canal and compress nerve tissue.
Other Causes of Foraminal Stenosis
- Spinal Tumors. Abnormal growths may develop inside the spinal cord itself or in the area that separates the cord and vertebrae. As they grow, these tumors could compress the spinal cord and nerve roots – only a specific MRI or CT Scan of the spine can further evaluate this. It is usually when the symptoms are severe, not going away and preliminary care is not getting results that this diagnosis is even considered. Many people come into my office terrified that this is the reason they are having pain and, most of the time, it is certainly not! We will evaluate them to see if conservative care is indicated. If not, a referral to a specialist will occur.
- Spinal Injuries. Any major trauma could cause fractures of one or vertebrae. Bone displaced from a spinal fracture could damage the inside of the spinal canal. Swelling associated with back surgery could also create pressure on the spinal cord or nerves.
- Paget’s Disease of the Bone. People with Paget’s Disease develop new bone faster than the normal rate. The new bone growth is weaker than normal producing soft bones susceptible to fracture. These bones could also develop deformed or abnormally large. This could decrease the space available in the spinal canal.
- Achondroplasia. This genetic disorder slows the rate at which bone forms during fetal development and in early childhood, resulting in dwarfism. People who have this condition are born with narrow spinal canals, so this is a genetic reason for spinal stenosis.
Symptoms of Foraminal Stenosis
Evidence of Spinal Stenosis could very easily be visible on X-rays, but the patient will show no signs or symptoms. When the symptoms do develop, it is usually a gradual process that worsens over time. Again, these symptoms mimic those of spinal stenosis, but is not technically this condition.
Cervical Foraminal Stenosis
- Neck or Shoulder Pain. Pain occurs when the nerves in the neck are compressed. However, cervical spinal stenosis can often exist with the absence of pain. If a patient is suffering from neck pain, the exact underlying cause needs to be identified. A chiropractor is a natural choice when first encountering this problem.
- Numbness or weakness. Numbness, weakness or tingling in a leg, foot, arm or hand could affect a person’s grip, balance and even their ability to walk. Again, the nerves of the neck branch out to the shoulders, elbows, wrists and fingers so symptoms like weakness, spasms, numbness or tingling can occur at a distal site away from the actual source. The nerves of the lower back branch out to the hip, leg, knees, ankles and feet and can cause symptoms like weakness, spasms, numbness or tingling.
- Loss of bowel or bladder control. Lumbar nerves to the bladder or bowel, resulting in incontinence. This is a serious condition and must be dealt with urgently.
Lumbar Foraminal Stenosis
Pain and/or cramping in the patient’s legs can occur when standing or walking for extended periods of time. This will usually decrease if the patient bends forward or sits down.
Foraminal stenosis can be a difficult condition to diagnose because the signs and symptoms resemble many other age-related conditions. Tests may be necessary to help diagnose the cause of a patient’s discomfort. Spinal X-rays won’t necessarily confirm that someone has foraminal stenosis. It will help rule out other problems that could cause similar symptoms.
In most cases, an MRI is the best choice for diagnosing foraminal stenosis. It can produce cross-sectional views of a person’s spine that X-rays cannot. Damage to discs and ligaments can be seen, as well as the presence of any space occupying lesions, which would produce pressure on the spinal cord or nerves.
Computerized Tomography (CT) combines X-ray images taken from various angles to create detailed, cross-sectional images of the body. It is able to show the shape and size of a patient’s spinal canal. In a CT myelogram, the scan takes place after a contrast dye is injected into the spinal column. This will outline the spinal cord and nerves and could also reveal herniated discs and bone spurs besides the diagnosis of foraminal stenosis.
In the past, the recommended treatment for foraminal stenosis was surgery. This concept is slowly starting to evolve as more physicians are recommending alternatives to surgery as being the first option. The most popular alternative is chiropractic care – specifically doctors trained in Spinal Decompression Therapy. This will help to very accurately traction the spine –either the cervical, thoracic or lumbar area. It gently opens up the space where the spinal nerves exit. This allows an “imbibition”, or an “enlivening” process to occur. This gentle pumping action takes pressure off the discs and facilitates the healing process. The sessions take anywhere from 12-20minutes are so relaxing that some patients even fall asleep!