Medical Media Images

Cervical Foraminal Stenosis

What is Cervical Foraminal Stenosis?

Cervical foraminal stenosis is a condition where the small opening on the side of the spine (foramen) is narrowed. The significance is that the spinal nerves travel through this opening and can be compressed by this condition. This is called a “Cervical Radiculopathy”.

What causes Cervical Foraminal Stenosis?

This condition is quite common as the spine ages. Contributing factors are:

  1. Discs which bulge, protrude, or herniate towards the spinal nerve.
  2. Bone spurs which develop on the vertebral body or facet joints on the back of the spine.

What is a Cervical Foraminal Stenosis?

When foraminal stenosis becomes severe, the spinal nerve can be significantly compressed and inflamed, causing nerve pain in the arm. This is called a cervical radiculopathy (inflammation of the spinal nerve). In this condition, the spinal nerve could lose function, resulting in numbness, tingling, or weakness of the arm muscles. This condition sometimes requires surgery to prevent permanent nerve damage.

What are the symptoms of a Cervical Foraminal Stenosis?

Here are some of the common symptoms from this condition:

1.Numbness in an arm

2.Weakness in an arm

3.Tingling in an arm

4. Loss of muscle mass in the arm

5.Pain the arm, especially when turning the head

6. Relief of pain when arm is placed over the head

How is Foraminal Stenosis diagnosed?

This condition is diagnosed by combining information from the patient history, physical examination, and special tests:

  1. History

The diagnosis revolves around asking the patient questions about some of the common symptoms of foraminal stenosis. Here are some:

  1. Do you have arm numbness?
  2. Do you have tingling in the arm?
  3. Do you have weakness in the arm?
  4. Have you lost muscle mass in the arm?
  5. Does your arm pain feel better when you place your hand on your head?
  6. Do you have sharp shooing pain the arm?

          2. Physical Examination

The spine specialist often examines the following:

  1. Upper Extremity (arms) Reflex testing
  2. Strength testing (motor) of the arms and legs
  3. Sensation testing (sensory) of the arms and legs
  4. Spurling’s test
  5. Inspection (looking) of the muscle mass of the arm to look for atrophy (loss of muscle mass)

      3. Imaging

A. X-Ray

X-Rays can be helpful to establish the anatomy of the neck. They can offer some information about the foramen, but not directly about the spinal canal or spinal cord.

B. MRI

MRI information is very helpful when evaluating a cervical foraminal stenosis. It can show the spinal nerves in detail and can accurately assess how much compression of each exists. It can also determine if there is swelling present in the nerve.

C. CT scan

CT scans can show the spinal canal and foramen accurately. However they have the disadvantage of not being able to show the spinal nerve and spinal cord in detail. A CT myelogram can show spinal stenosis in detail. However, this requires a significant radiation exposure.

4. Electromyogram/Nerve Conduction Study (EMG/NCS)

An EMG/NCS test will test the nerve involved in the compression. These tests can show the nerve’s function, signs of a nerve deficit, and if a nerve is getting better.

How is Cervical Foraminal Stenosis treated?

The treatment of foraminal stenosis is dependent on the severity of the case. Surgery is reserved for severe conditions not responding to non-surgical care.

 

  1. Non-Surgical Care

A. Alternative Health Care

There are some alternative health interventions which can complement medical care for cervical radiculopathies. Massage Therapists have techniques which can help with the muscle components of symptoms form this condition. Acupuncture, Meditation Exercises, and Herbal Remedies are some examples of other Alternative Medicine options.

B. Chiropractic Care

Chiropractic manipulation can help with the symptoms from a Cervical Radiculopathy, especially those related to alignment issues in the neck.

C. Spine Exercises

Spine exercises can help maintain the muscle tone and balance which is commonly lost due to pain.

D. Physical Therapy (PT)

Traction can help with compressed spinal nerves in a Cervical Foraminal Stenosis. Specialized exercises can maintain muscle strength and function. Ultrasound, manual treatments, and electrical stimulation can help with the muscle pain and spasm.

E. Self Help Devices

Neck Braces can help with the symptoms from cervical foraminal stenosis by keeping the head in the most comfortable position. Usually soft braces are used. Neck pillows and Home Traction Devices are other examples of potentially helpful Self Help Devices.

F. Medications

  1. Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)
  2. Steroids
  3. Muscle Relaxants
  4. Pain killers
  5. Nerve pain medications

G. Injections

Spine Injections can be very helpful for the nerve pain from a Cervical Foraminal Stenosis. Here are some possible options:

 

  1. Cervical Interlaminar ESI
  2. Cervical Transforaminal ESI
  3. Cervical Nerve Root block   

2. Surgical Care

Surgery is sometimes required for severe cases of Cervical Foraminal Stenosis if the non-surgical care has not been found to be effective. In cases of significant arm weakness and muscle loss from the nerve compression, surgery can be offered earlier. Here are some surgical procedures offered for Cervical Foraminal Stenosis:

  1. Cervical Laminotomy and Discectomy
  2. Cervical Laminotomy and Foraminotomy
  3. Cervical Endoscopic Discectomy
  4. Anterior Cervical Decompression and Fusion (ACDF)
  5. Cervical Artificial Disc Replacement (C-ADR)