Neural Formanial Narrowing

Exploring the Complexities of Spinal Neural Foraminal Narrowing

The spine comprises a total of 33 vertebrae. Each has openings to allow nerves that originate from the spinal cord to travel to other anatomical regions. When these openings, known as neural foramen, become constricted or obstructed, pressure can be exerted on the nerves. It is referred to as “Neural Foraminal Stenosis” or “Neural Foraminal Narrowing” (1)

What are the types of Neural Foraminal Narrowing?

Based on anatomical location, Neural Foraminal Narrowing is of three types:

• Cervical Foraminal Narrowing: Occurs in the cervical spine, affecting the neck and upper extremities.
• Thoracic Foraminal Narrowing: Less common and occurs in the thoracic region, potentially affecting the trunk and lower extremities
• Lumbar Foraminal Narrowing: Occurs in the lumbar spine, affecting the lower back and legs (2)

Based on Degree of Severity, Neural Foraminal Narrowing is of three types:

• Mild Foraminal Narrowing: Minimal symptoms with occasional discomfort or pain.
• Moderate Foraminal Narrowing: More significant symptoms such as persistent pain, numbness, and muscle weakness but typically responsive to conservative treatment.
• Severe Foraminal Narrowing: Marked symptoms that are debilitating and usually necessitate surgical intervention (2, 3)

Thoracic Foraminal Narrowing:

• Balance issues
• Upper back pain
• Numbness or tingling and pain around or below the abdomen
• Radiating pain around the ribcage or even into the abdomen

Lumbar foraminal Narrowing:

• Low Back Pain than may come and go
• Numbness or tingling in the lower extremities
• Reduced strength in the legs and feet
• Radiating pain down the buttocks in to the feet
• Loss of bladder control
• Pain that improves with sitting, leaning forward, or bending forward (3, 4)

What causes Neural Foraminal Narrowing?

The majority of neural foraminal Narrowing causes are degenerative, meaning they develop gradually with age. It may also result from physical trauma or accidents. Other causes include:

• Osteoarthritis: Bone spurs can form as a result of cartilage breakdown in the facet joints, intruding into the neural foramina.
• Disc Degeneration: The intervertebral discs may become herniated, further narrowing the space in the neural region.
• Paget’s disease: Which can cause an overgrowth in the vertebral bone, leading the tightening of the neural space.
• Ligamentum Flavum Hypertrophy: The ligaments may become enlarged which can bulge into your foramen
• Spondylolisthesis: One vertebra slipping over another can reduce the size of the neural foramen
• Facet Joint Subluxation: Misalignment of the facet joints can result in foraminal narrowing

Besides these, congenital causes such as Congenital Stenosis, where individuals are naturally born with a narrow foramen can also lead to Neural Foraminal Narrowing. Moreover, Accidents or traumatic injury into the spinal column or the surrounding muscles and ligaments can result in this condition (5, 6).

How Is Neural Foraminal Narrowing Diagnosed?

Physicians usually diagnose Neural Foraminal Narrowing using a combination of clinical evaluation with Imaging study results.

The imaging studies that can help detect Neural Foraminal Narrowing are:

• X-ray
• MRI (Magnetic Resonance Imaging)
• CT (Computed Tomography) Scan
• EMG (Electromyography) (6)

How Is Neural Foraminal Narrowing Treated?

The management of neural foraminal narrowing comprises conservative and surgical interventions, with the former primarily aiming to alleviate symptoms and restore function.

Conservative Management:

• Physical therapy can alleviate pressure on nerve roots through exercises that strengthen muscles and correct posture.
• Pharmacological treatment: to alleviate symptoms, nonsteroidal anti-inflammatory medications and muscle relaxants may be prescribed.

Surgical Interventions:

• Foraminotomy: A foraminotomy is a surgical procedure that aims to alleviate nerve compression by enlarging the neural foramen.
• Discectomy: A discectomy is a surgical procedure that involves the removal of a segment of the intervertebral disc, which may be contributing to the condition known as foraminal constriction.
• Spinal Fusion: The procedure of spinal fusion entails the fusion of two or more vertebrae in order to provide stability to the spine. This surgical intervention is generally reserved for instances where there is evidence of spinal instability.
• Laminectomy: A laminectomy is a surgical procedure involving the excision of the lamina, a portion of the spinal bone, with the purpose of increasing the available space for the nerves.
• Endoscopic Techniques: Endoscopic techniques have been increasingly adopted due to their less invasive nature; however, their successful implementation needs expert hands (8).

The Key to Thriving

• Pain Management: Effective pain management is crucial for chordoma recovery. This involves ongoing medication management, making lifestyle adjustments, and exploring alternative pain management techniques.
• Proactive Monitoring: It’s essential to be proactive about one’s health by following prescribed treatments, managing coexisting medical conditions, and promptly reporting any new or worsening symptoms to the healthcare team.

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Bibliography

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3. Alvin MD, Qureshi S, Klineberg E, Riew KD, Fischer DJ, Norvell DC, et al. Cervical degenerative disease: systematic review of economic analyses. Spine. 2014;39(22S):S53-S64.
4. Genevay S, Atlas SJ. Lumbar spinal stenosis. Best practice & research Clinical rheumatology. 2010;24(2):253-65.
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6. Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen L, Deyo R, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American journal of neuroradiology. 2015;36(4):811-6.
7. Childress MA, Becker BA. Nonoperative management of cervical radiculopathy. American family physician. 2016;93(9):746-54.
8. Fehlings MG, Tetreault LA, Riew KD, Middleton JW, Wang JC. A clinical practice guideline for the management of degenerative cervical myelopathy: introduction, rationale, and scope. Sage Publications Sage CA: Los Angeles, CA; 2017. p. 21S-7S.