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Lumbar Foraminal Stenosis

What is Lumbar Foraminal Stenosis?

Lumbar foraminal stenosis is a condition where the nerve channel of the vertebrae is narrowed. The significance is that the spinal nerves travel through this channel and can be compressed by this condition. This is called a “Lumbar Radiculopathy”.

What causes Lumbar 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 Lumbar Radiculopathy?

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

What are the symptoms of Lumbar Foraminal Stenosis?

Here are some of the common symptoms from this condition:

1. Numbness in a leg

2. Weakness in a leg

3. Tingling in a leg

4. Loss of muscle mass in the leg

5. Pain in the leg (sciatica)

How is Lumbar 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 sharp shooting pain in the leg?
  2. Do you have leg numbness?
  3. Do you have tingling in the leg?
  4. Do you have weakness in the leg?
  5. Have you lost muscle mass in the leg?

      2. Physical Examination

The spine specialist often examines the following:

  1. Reflex testing of the legs
  2. Strength testing (motor) legs
  3. Sensation testing (sensory) of the legs
  4. Straight Leg Raising 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 low back. They can offer some information about the foramen, but not directly about the spinal nerve.


MRI information is very helpful when evaluating lumbar 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 foramen accurately. However they have the disadvantage of not being able to show the spinal nerve in detail. A CT myelogram can show the compression of a spinal nerve in detail. However, this requires a significant radiation exposure.

D. 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 Lumbar Foraminal Stenosis treated?

The treatment of lumbar 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

Alternative Health care options can often complement conventional medical care. Massage Therapy, Acupuncture, Meditation exercises and Herbal Remedies can all help with the pain from this condition. Massage Therapists have techniques which can help with the muscle components of symptoms form this condition.

B. Nutrition and Weight Loss

Proper nutrition and weight loss can have a positive impact on many spine conditions. Excess weight on the spine often contributes to the symptoms of pain and spasms.

C. Chiropractic Care

Chiropractic care including manipulation and adjustments of the spine can help with the pain and spasms from this condition.

D. Spine Exercises

Spine exercises can help with the muscle pain and tightness from this condition. Exercise also increases the amount of oxygen delivered to the spine which can help with healing. Pilates, Yoga and T’ai Chi can help maintain the spine’s flexibility.

E. Physical Therapy (PT)

PT has many modalities to offer for this condition. They can range from Manual Therapy and Exercises to Traction and Ultrasound Treatments. Specialized exercises can maintain muscle strength and function. Ultrasound, manual treatments, and electrical stimulation can help with the muscle pain and spasm.

F. Self Help Tools

Self Help Tools are items which can be purchased to help with back pain. They range from Back Braces to Back Mattresses and Ergonomic Devices such as chairs and computer accessories. There are also a variety of Non-Surgical Decompression devices on the market which may offer some benefit.

G. Spine Medications

Here are some of the common groups of medications which are available for this condition:

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

H. Injections

Epidural steroid injections can help with foraminal stenosis. Here are some options:

  1. Lumbar Interlaminar ESI
  2. Lumbar Transforaminal ESI
  3. Lumbar Nerve Root block
  4. Caudal Epidural Steroid Injection


          2. Surgical Care

Surgery is sometimes required for severe cases of Lumbar Foraminal Stenosis if the non-surgical care has not been found to be effective. In cases of significant leg weakness from the nerve compression, surgery can be offered earlier.

Here are some surgical procedures offered for Lumbar Foraminal Stenosis:

  1. Endoscopic Lumbar Spine Surgery
  2. Lumbar Interspinous Process Spacers
  3. Lumbar Laminotomy and Foraminotomy
  4. Lumbar Laminectomy