Foramenstenose

Foramenstenose, also known as foraminal stenosis, is the narrowing of the neural foramen through which a spinal nerve root exits the spinal canal. This constriction can occur in any spinal region but is most commonly described in the cervical and lumbar spine, where it can compress the exiting nerve root and cause radicular symptoms.

The condition typically results from degenerative changes in the spine. Contributing factors include disc height loss, facet joint arthropathy, bone spur (osteophyte) formation, and thickening of the soft tissues such as the ligamentum flavum. In the cervical region, uncovertebral joint hypertrophy and foraminal crowding may play a prominent role; in the lumbar region, foraminal encroachment is often related to facet degeneration and disc collapse. Traumatic injury, prior surgery, or congenital narrow foramina can also predispose to stenosis.

Patients usually present with unilateral or bilateral radicular pain that follows the distribution of the affected nerve root. Symptoms may include numbness, tingling, weakness, and occasional sensory or motor deficits in the corresponding myotome. Neurogenic claudication is more typical of central canal stenosis, but foraminal stenosis can mimic or accompany it, especially if multiple levels are involved. Physical examination may reveal dermatomal sensory changes, diminished reflexes, or focal weakness.

Diagnosis relies primarily on imaging. Magnetic resonance imaging (MRI) is the preferred modality to visualize soft tissues and nerve compression. Computed tomography (CT), often with CT myelography, provides detailed bony anatomy when MRI is inconclusive or contraindicated. Plain radiographs can assess alignment and degenerative changes. Diagnostic nerve root blocks may aid in confirming the symptomatic level.

Treatment starts with conservative measures: physical therapy, activity modification, nonsteroidal anti-inflammatory drugs, and epidural steroid injections. If symptoms persist or there is progressive neurologic deficit, surgical decompression via foraminal foraminotomy or similar techniques may be pursued, sometimes with fusion if spinal instability is present. prognosis varies with severity and comorbidity.