Open pathways keep your body moving freely and feeling good. Spinal stenosis and foraminal stenosis describe the narrowing of the canals in your spine. Spinal stenosis is the narrowing of the canals through which the spinal cord travels, foraminal stenosis is the narrowing through which the spinal nerves travel before exiting the spine. This narrowing is caused by the degenerative process that unfortunately occurs as we age, and can be associated with bulging discs, arthritic bone spurs, or the thickening of tissues such as ligaments. When the canals get too narrow, pain and/or loss of function can occur.
The Spine and Stenosis
The spine, or vertebral column, is made up of 33 vertebrae (individual bone segments) that are stacked one on top of the other and spaced apart by small, shock-absorbing, sponge-like structures called intervertebral discs. The purpose of the spine is to support the body’s weight, protect the spinal cord, and support us in standing, sitting, walking, and all other activities of daily life. The spinal cord runs the length of the spine down to the upper portion of the low back and is encased within the hollow sections of these vertebrae. Spinal nerves branch off of the spinal cord at each level and exit the spinal column through holes between each pair of vertebrae called “foramen.” It is in these two areas—the hollow part of the vertebrae where the spinal cord runs down our backs and the holes between the vertebrae where the spinal nerves exit the vertebral column—that stenosis occurs.
A View Into Spinal Stenosis
A View into Foraminal Stenosis
The Degenerative Process
As people age, the forces of gravity and muscle contractions press the vertebrae together and compress the intervertebral discs. Years and years of pressure dehydrate the discs, causing them to shrink and wear down. As a result, the holes through which the spinal nerves travel get smaller. It is here where the process of stenosis begins. Once one part of the spine deteriorates, it directly affects other nearby regions, setting off a chain reaction. As you lose disc height and function, the vertebral facet joints take on more of your body weight. Because these joints are constantly involved with spine motion, they wear down and lose cartilage, a process that is quickened by the additional weight loads they now carry—a job that was supposed to be fulfilled by your discs. This in turn can cause bone spurs to form and ligaments to thicken. The result is spinal or foraminal stenosis.
What Causes Stenosis Back and Neck Pain?
Pain from spinal or foraminal stenosis happens when the canals get so narrow certain movements cause compression of the spinal cord or spinal nerves. Pain is usually felt in the back, neck, or in the areas to which the affected nerve (or the part of the spinal cord) supply sensation and function. Typically, the pain occurs in the arms or hands in the case of cervical (neck) stenosis, or in the legs and feet with lumbar (low back) stenosis. When the compression is severe, there can be a loss of sensation or tingling in the associated skin area or a loss of function in the associated muscles.
Treatment for Spinal Stenosis and Foraminal Stenosis
In mild, moderate, and sometimes even severe cases of spinal or foraminal stenosis, exercise therapy and behavioral modification are the best forms of treatment. The goals of treatment are to: 1) build strength in the muscles that support the spine and 2) change the way you move to better support the spine and take pressure off of the areas of stenosis. Injections of inflammation reducing drugs can also be successful for the short-term reduction of symptoms from spinal and foraminal stenosis. A comprehensive plan can lead to significantly reduced or completely relieved symptoms. Those with pain, tingling or numbness in the buttocks, legs, feet, arms, or hands should always visit a doctor before undertaking any exercise program to make sure that it’s safe for you. Those who are experiencing a loss of function (inability or lessened ability to lift the foot, squeeze hand, etc.) should consult a doctor immediately as this can be an irreversible loss of function. Surgery may be required for cases of stenosis that have resulted in severe symptoms , especially a loss of function. If your doctor recommends surgery, a second opinion with a trusted surgeon is strongly recommended before committing to the procedure.
Written by Dr. Jeremy James. Dr. James founded and was director of the Aspen Club Back Institute in Aspen, Colorado, is the coauthor of the bestselling The Younger Next Year Back Book and earned his Doctor of Chiropractic from the University of Western States. Learn more about Dr. James here.