Neural Foraminal Stenosis

Neural Foramina

Neural foramina are a type of spinal structure which consists of a nerve root that exits the spinal column. A nerve root is a part of a spinal nerve composed of two parts, motor and sensory. A motor nerve root carries commands from the brain to the spinal cord, whereas a sensory nerve carries signals like pain, temperature and touch from the body to the brain. An exit nerve root is sensory as it takes information from the body to the brain and is present in neural foramina. It is generally a result of the wear and tear caused due to an injury or ageing. Studies have shown that around 5 in 1000 people over 50 years tend to have or are at a high risk of developing spinal stenosis ^[2].

One of the major types of disorders related to neural foramina includes neural foraminal stenosis, which is the narrowing or compression of the place where the nerve root resides, resulting in neural foraminal stenosis or narrowing. It can be symptomatic or asymptomatic, depending on its impact on the overall functioning of the spine. In the symptomatic type, its symptoms include the following:

1. Individuals suffering from neural foramina suffer from pain at the back of the neck region.
2. A shooting pain that goes down from the lower back region to the legs. Individuals can also experience shooting pain in their arms.
3. Unable to maintain proper walking or balance.
4. Individuals often experience a sense of numbness or weakness in certain body parts like arms, feet, and legs.
5. Severe cases of foraminal stenosis can result in the development of paralysis.

Neural Foraminal Stenosis

Neural foraminal stenosis is a type of spinal deformity that occurs when the vertebral openings located in the spine get pressed or blocked. The location of the symptoms depends on the region of the spine where the narrowing occurs. If the narrowing occurs at the cervical spine, then the pain occurs at the neck region, and if the narrowing occurs at the thoracic spine, then the pain occurs in the upper back area, whereas if the lumbar spine is affected, then the pain occurs at the lower back region. Doctors or medical experts can use imaging approaches like X-rays, and conventional CT scans to get the type of narrowing based on its location. However, studies suggest that MRI can more precisely detect and identify the intensity of narrowing.

Neural Foraminal Narrowing

A small opening between each vertebra through which the nerve root passes is known as the neural foramen. The tightening or compression of this opening results in neural foraminal narrowing. In general, neural foraminal narrowing shows no symptoms. However, if a nerve gets compressed due to the narrowing, an individual might experience pain in the back region. The location of the narrowing of the foramina decides the type and the symptoms of neural foramina. E.g., if the nerve root of the cervical region is affected, then its symptom would include weakness or pain in the lower neck region, whereas if the nerve root of the lumbar region is involved, then its sign would consist of pain, weakness or even paralysis in the lower back region of an individual.

Foraminal Stenosis Treatment

Symptom-free foraminal stenosis generally does not require any treatment. The pain caused due to neural foraminal narrowing or stenosis could be handled through anti-inflammatory pain medications. However, local anaesthetics or steroid treatment injections can cure the higher long-term pain symptoms of foraminal narrowing. The steroid injection is given to the blood or at the compression location. Physical therapy techniques that aim to improve the overall movement of the back region and affect the narrowing space through decompression can also play a significant role in treating foraminal stenosis. Surgical methods can also decompress the narrowed nerve and result in treating foraminal narrowing or stenosis entirely. Electrical stimulation also can cure extreme levels of pain if surgical procedures fail.

Lateral Recess Stenosis

A type of nerve root narrowing or compression in the lower back portion is lateral recess stenosis. It results in leg pain that relieves with standing or leg pain that reduces with sitting. It is different from other types of foraminal narrowing as its volume or intensity changes with spinal position; therefore, bending forward can increase the intensity of pain caused due to lateral narrowing. The narrowness of nerve roots affects sensory nerves by decreasing their blood supply, thereby causing difficulty or discomfort in walking, standing, sitting and bending are a few of its common symptoms.

Bilateral Neural Foraminal Stenosis

The symptoms of foraminal stenosis generally occur at the side or region of the body where the nerve root's narrowing occurs. Thus, when a neural foraminal stenosis or narrowing occurs at the right side of the canal, the symptoms related to it appear on the right side of the body, like the right back region. However, bilateral neural foraminal stenosis occurs when both directions of the body experience the symptoms caused due to the narrowing of both sides of the foraminal canal.

Conclusion

Foraminal stenosis or narrowing results from compression at the small openings of the spinal column and can be without any visible symptoms in most cases. However, if its severity is high, individuals might experience pain, weakness and even paralysis. It is one of the major disorders in the elderly population. Imaging and endoscopy have the potential to detect the intensity, distribution, location and type of foraminal narrowing. The symptoms of foraminal stenosis or narrowing depend significantly on the spot and power of the narrowness. In the majority of cases, the pain is treated through pain reliefs, anti-inflammatory medications and steroidal injections, whereas surgical techniques and physical therapy have the potential to cause structural changes that can decompress the nerve root.

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Neural foraminal stenosis - References

1. ^ Ann-Kathrin Ditges A. et. al. (2022). Neuroforamen stenosis remains a challenge in conventional computed tomography and new dual-energy techniques. Scientific Reports, 12, 678. https://doi.org/10.1038/s41598-022-10673-3. Retrieved 4 Dec 2022.
2. ^ Melancia J. et. al. (2014). Spinal stenosis. Handbook of Clinical Neurology, 119, 541-9. https://doi.org/10.1016/b978-0-7020-4086-3.00035-7. Retrieved 4 Dec 2022.
3. ^ The Spinal Foundation. (n.d.). Lateral Recess Stenosis and Treatment. Retrieved from https://www.spinal-foundation.org/conditions/lateral-recess-stenosis-and-treatment. Retrieved 4 Dec 2022.