Foraminal Stenosis Neck
Foraminal stenosis in the neck can cause neck pain, pain that radiates across the shoulders, down the arms and into the hands, problems with balance and movement of the limbs and even muscle atrophy over the longer term. These symptoms are due to compression of the cervical spinal nerves through a narrowing of the foramina which the nerves pass through as they exit the cervical spine. Causes of compression include the growth of bone spurs in the neck (osteophytes), herniated disc material, and fracture or structural deficit in the spine leading to a narrowing of the space around the spinal nerves in the neck. Slipped or bulging discs, disc degeneration, ligament thickening or calcification, and joint enlargement (such as the uncinate process) due to arthritic conditions can also cause foraminal stenosis in the neck, as can spondylolisthesis. The obstruction can also impinge upon the spinal cord and cause pain, numbness, and progressive weakness.
Foraminal Stenosis in the Neck Symptoms
Symptoms of cervical foraminal stenosis include pain, numbness, weakness, and paraesthesia, or the feeling of ‘pins and needles’ in the neck, shoulders, arms and hands. The location of the stenosis is often identified through a detailed symptom history as each cervical nerve innervates a specific area. Altered sensation in the little finger for example can indicate a pinched nerve at a different vertebral level to that producing the symptom of weakness in the thumb and inside of the hand. The loss of reflexes can indicate severe foraminal stenosis and require immediate intervention to relieve the pressure on the nerve.
Bilateral Foraminal Stenosis and Diagnosis
Occasionally, symptoms will be experienced on both sides of the body in a condition called bilateral foraminal stenosis. This is where the foramen on each side of a vertebrae are narrow causing nerve compression and altered nerve function. One-sided foraminal stenosis is, however, more common in the neck with symptoms experienced on either the left or right side of the upper body. In addition to a thorough history the physician will also conduct a physical check-up including the testing of reflexes where appropriate. Diagnostic imaging such as MRI scans or X-Rays are helpful in identifying structural problems, such as osteophyte growth which are responsible for the foraminal stenosis in the neck. Patients may be given selective nerve root blocks in order to further clarify the source of their symptoms, but this is more commonly conducted in lumbar foraminal stenosis as the cervical spine can present difficulties for epidural steroid injections.
Foraminal Stenosis in the Neck Treatment
The structures in the cervical spine are often very tightly packed, which makes stenosis and its myriad symptoms likely to occur following acute trauma or chronic degeneration. Surgery on the cervical spine may be recommended where the patient is likely to find little relief through conservative treatments, where a regimen of conservative therapy has failed to relieve symptoms, or where the damage to the cervical spinal nerves and spinal cord may be severe if decompression is not achieved quickly. Chronic conditions, such as arthritis and the thickening of spinal ligaments can also cause foraminal stenosis, as can the enlargement of the uncinate process in the spinal canal; these are unlikely to cause acute nerve damage, however, and are usually managed conservatively.
Conservative Therapy for Foraminal Stenosis in the Neck
In some cases a bulging or herniated disc may be addressed through a combination of rest, physical therapy, anti-inflammatory medications and analgesics, and traction to encourage it to heal. In the majority of cases foraminal stenosis connected to disc herniation or bulging is relieved using such therapies and back surgery is unnecessary. For patients with foraminal stenosis in the neck from other causes initial treatment is often a course of physical therapy, rest, and mild stretching exercises along with NSAIDs, and pain medication. Unfortunately, conservative treatments are often ineffective for foraminal stenosis where there is clear evidence of the growth of bone spurs, ligament calcification, or structural defect, despite their effectiveness in treating disc herniation. Patients are encouraged to attain and maintain a healthy weight in order to relieve excess pressure on the joints, to engage in regular activity to promote good general health, strength, and circulation, and to quit smoking if they have not already done so as this seriously compromises back health and may prevent a patient being considered for back surgery in some cases.
Two levels of foraminal stenosis due to facet hypertrophy
and uncovertebral joint hypertrophy
Foraminal Stenosis in the Neck Surgery
Back surgery for foraminal stenosis in the neck can involve an open procedure such as a traditional foraminotomy, laminotomy, or laminectomy with or without fusion. These surgeries carry a significant amount of risk including the chance of infection, scarring, blood loss, bruising, spinal instability, and prolonged recovery and pain. They are also quite costly and necessitate a number of weeks away from work to optimize recovery. Minimally invasive cervical spinal surgery is preferred by many patients as it can reduce a number of the risks of the open procedures and effect a positive outcome in a shorter space of time with a less protracted recovery. Endoscopic microlaminoforaminotomy or laser spine surgery can remove obstructive bone spurs, disc fragments, and ligament calcification through a small incision in the neck as effectively in most cases as an open procedure. The risk of creating spinal instability is also considerable lessened as little structural material, if any, is removed from the spine itself.
Results of Surgery for Cervical Foraminal Stenosis
Minimally invasive surgery may be conducted using a mild sedative and local anaesthetic, in contrast to the use of general anaesthetic in traditional procedures. This means that patients are at less risk of thrombophlebitis (deep-vein thrombosis) as they are ambulatory much more quickly after surgery. Many patients actually feel a degree of relief from their symptoms shortly after their procedure and some can sense the removal of pressure on the nerve root during the procedure itself. It usually takes up to three months to feel the full effect of foraminal stenosis surgery and if no improvement is evident by this time then the procedure is likely to have been ineffective. Further surgery may be considered if there is a suspicion that another vertebral level is the cause of the nerve pain in the neck, but for some patients it may simply be the case that the nerve damage was too severe and is irrecoverable.