Foraminal Stenosis


 

Constriction of the nerve roots leaving the spine by bone, disc bulge/herniation, scar tissue, or ligament thickening produces a type of pain called radicular pain. 

This pain travels down the nerve root to the far extremities, and can be electric in nature or achy, and may be much worse in certain positions such as neck extension producing pain into the hand. 

Overgrowth of bone from spondylosis (arthritis of the spine) or a slippage of one vertebrae on another (spondylolisthesis) can cause this positional pain. 

Diagnosis is made by MRI, CT scan, neurography, or 3-D CT as seen below.  Disc height of <4mm or foraminal height <15mm produces foraminal stenosis symptoms in more than 80% of patients.  Also, foraminal probing with a blunt probe may be useful as is endoscopic evaluation. 

Treatment consists of transforaminal steroids and when necessary, surgical intervention.  New laser surgery techniques are now being used (SED, ELF) to open up the bone while leaving the nerve unharmed, all performed through a needle or cannula. 

Traditional surgical techniques involve use of burrs and drills on the bone along with occasional laminectomy (removal of the roof of the spine).
 

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