Foraminal stenosis: what it is, types, symptoms, and exercises

Generally, foraminal stenosis is a pathology that appears in adulthood, and in most cases the main cause is osteoarthritis of the spine and the intervertebral discs. We invite you to read this article to find out more about this condition.

To help you understand what foraminal stenosis is, we’ll begin by explaining what stenosis is. The term “stenosis” is used in medicine to refer to a process of narrowing of some canal or passage way in the body. Therefore, when we talk about foraminal stenosis we refer to the pathological narrowing that occurs in the intervertebral foramen space.  

The intervertebral foramen is an opening found between two spinal vertebrae, which can be cervical, thoracic, or lumbar. It is common for that foraminal narrowing to occur due to degenerative changes in the anatomy of the spine, which can lead to compression of the spinal nerve roots.  

Types of foraminal stenosis 

The doctor will determine the type of foraminal stenosis depending on the area of the body that is affected. Below, we describe the two most frequent typologies:  

1. Cervical foraminal stenosis: In this type of stenosis, when the spinal canal narrows, it can compress the nerve roots at the place where they leave the spinal cord at the cervical level. A patient with cervical foraminal stenosis may experience pain, stiffness, numbness, or weakness in the neck and arms. 
   
   The main cause is the natural aging process of the cervical spine, which can cause a disc to bulge or the ligaments or components of the joints in that area to thicken. Very rarely, the narrowing of the canal is from birth, because of the way the bones have formed.
    
2. Lumbar foraminal stenosis: this is the most frequent type, because the lower back is the area of the body that bears the most weight. Here, also, we are talking of a narrowing of the vertebral canal at the point where the nerves exit. Those who suffer from it may experience low back pain and discomfort in both legs, hips and buttocks. Elderly people are the ones who commonly suffer from this type of stenosis, which arises as a result of arthritic degeneration of the spine. 
   
   There are two types of lumbar foraminal stenosis, which we describe here in very general terms:  

• Congenital: it this can occur in isolation or within the context of rare diseases.  
• Osteoarthritic degeneration: the degeneration of the intervertebral discs or of the bridges that join the vertebrae, can cause a build-up of bone in the space between them, narrowing the space of the vertebral canal 

Which doctors treat these conditions? Meet our team!

Common symptoms of foraminal stenosis 

Previously, we described the symptoms in a very general way, with reference to the two most common typologies. Now we will focus in greater detail on the lumbar spine, the area of the back that most often suffers foraminal stenosis.  

The patient may experience low back pain that varies depending on the severity of the disease, posture, or physical stress. Among the most common symptoms that appear are the following:  

• Low back pain that radiates or reaches the legs (lumbar root pain) 
• Muscle tension in the lumbar region 
• Feeling of weakness and loss of muscle strength when using the legs 

As it is a condition in which some lumbar nerve root is compressed, neurological disorders often develop in certain areas of the leg. Foraminal stenosis mainly affects the region innervated by the affected nerve. The most frequently affected nerve roots are L4, L5 and S1, since as we said before, the area that receives the most weight load is most affected, and these are the lowest spinal nerve roots. This can cause symptoms such as: 

• L4 root: weakness when trying to straighten the knee, hypoesthesia, or loss of sensation; burning, tingling (known as paresthesia) or the inside posterolateral part of the leg feeling cold.
    
• Root L5: weakness and difficulty in lifting the foot and/or toes upward (foot drop). Hypoesthesia, burning, tingling, or feeling cold in the back of the leg, ankle, and big toe.
   
• Root S1: weakness or difficulty in trying to stand on tiptoe, hypoesthesia, tingling or feeling of cold in the back of the leg and sole of the foot. 

Foraminal stenosis surgery 

Conservative treatment options, including physical therapy and pain relievers, help most patients suffering from foraminal stenosis, so this is the best place to start. However, a surgical procedure can be considered if conservative treatments do not achieve the desired result or if the patient suffers so much pain that it limits their daily activities.  

The goal of the surgery in these cases is to relieve pain in the region where the narrowing is. There are currently several surgical methods that can be used: 

• Decompression surgery: This procedure is performed to relieve the compressed nerves, and consists of the enlargement of the space in the spinal canal that is compressed.
    
• Arthrodesis or fusion: This surgery consists of joining and stabilizing the vertebrae with screws and plates. This keeps them from slipping and causing the exit holes of the nerves to narrow. In many cases this surgery is accompanied with decompression.
   
• Implants or interspinous spacers: implants are used to connect the spinous processes of the vertebral bodies and prevent the spinal column from leaning excessively backwards in the area with narrowing, thus keeping the nerve exit holes from closing. This surgery is still performed today, although it is chosen less and less often. 

At Instituto Clavel, whenever possible, we choose minimally invasive techniques for surgery. This is easier on the patient and helps them recover more quickly. 

Endoscopic lumbar surgery to treat foraminal stenosis

Exercises for foraminal stenosis 

Before you try any of the exercises that we recommend below, it is important that you get approval from your doctor. Remember that every patient and every case is unique. Your doctor should give you guidance on the best treatment for your foraminal stenosis according to your physical condition and overall health.  

As we said in previous paragraphs, the stenosis occurs most frequently at the level of the lumbar spine and it is for this reason that the exercises we have selected are focused on treating this area of the body.  

1. Alternate arm-leg lift: Starting on your hands and knees on the floor, extend one arm out in front of you. Hold for 5 seconds and return to the starting position. Then, lift and extend the opposite leg out behind you. Hold for 5 seconds and rest. Try to perform 10 repetitions alternating sides.
    
2. Lumbosacral floor stretch: Start on your hands and knees on the floor. Then lower your body, as if to sit on your heels, stretch your arms out in front of you on the floor, keeping your head between your arms and bringing your face as close to the floor as possible. Stay in that position for 30 seconds and rest. Try to do 3 repetitions.
    
3. Bridge: Begin lying on your back with your arms close to your sides, your knees bent and your feet flat on the floor. Keeping your head and shoulders on the ground, raise your pelvis until your thighs form a straight line from your knees to your torso. Hold the position for 5 seconds and rest. Repeat the movement 10 times.

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