Stenosis is defined as a narrowing of a normally larger opening. Nerves exit an opening in the spinal column through the neuroforamen or spinal canal. When the spinal nerves become compressed or even trapped because the neuroforamen is partially or completely closed, we can associate this to spinal stenosis. Although quite similar to spinal stenosis, foraminal stenosis affects one or more vertebral foramen.
While this condition is sometimes congenital, it is normally brought about by the normal aging process. Forminal stenosis mostly occurs at the lowest lumbar level of the back. Although not all stenosis cases are critical, if ignored, loss of function may occur if nerves die. The ability to feel and move can be part of this function loss.
Typical symptoms include numbness, sensations of burning, tingling or pins and needles in the affected extremity or general weakness in the extremity.
If conservative treatments of anti-inflammatory drugs, rest or avoidance of strenuous movements are not successful or if there is progressive weakness or loss of bowel/bladder function, surgery may be necessary.
In the case of foraminal stenosis, exiting nerves in the spinal canal or foramen are being compressed and surgery is used to remove problems that are causing the compression in the affected area. This can be handled in a few different ways. The traditional lumbar decompression surgery is a laminectomy. A spinal fusion may be required when too much of the structure that keeps the spine stable is removed while freeing the nerve.
Surgery can be very successful when dealing with foraminal stenosis, in most cases for the leg symptoms. If the nerve has been compressed for an extended length of time or depending on the severity of the nerve compression, permanent nerve damage may have occurred which is often not curable through surgery. Although the relief of the leg pain associated with foraminal stenosis is quite reliable the success rate for back pain relief through surgery is less reliable.
At Center for Regenerative Therapy and Pain Management, we opt for a minimally invasive procedure whenever possible. In this case, we open the foramen through an arthroscopic procedure. This can be done with local anesthesia and can be performed in an outpatient surgical setting.
A small incision is made and a round tube is put into the incision, creating a small opening to the spine. The muscles are pushed out of the way and the surgeon can begin removing the bone and tissue that is compressing the nerve without distress to the patient. Some patients feel immediate relief during the procedure as the nerve is released. When the procedure is complete, the tube is slowly removed, allowing the muscles to move back into place.