What is neural foramen stenosis?

The spinal cord and the nerve root derived from it are located in the spinal canal. In this nerve root there are both: the vegetative and sensitive nerve fibers. The nerve root initially runs in the spinal canal and leaves it via an exit opening (Neural Foramen)  to reaches its final destination: muscles, skin, joints, bladder and other organs. The exit opening in the lumbar spine area is about 18-22 millimeters high and 5-8 millimeters wide and in the cervical spine area 10-14 millimeters high and 5-7 millimeters wide. If there is a restriction in the area of ​​the openings, there is a Neural Foramen Stenosis (NFS) – that is to say: narrowness of the nerve outlet.

Predominantly, such narrowing of the neural foramen occurs as a result of bone attachments in the context of degeneration. In case of advanced signs of wear, calcium deposits and arthrosis of the vertebral arch joints additionally narrow to the root outlet openings. The tightness is also increased by a loss of height of the intervertebral discs and the associated changes in position. The constriction irritates or even damages the spinal nerves. Often the Neural Foramen Stenosis is accompanied by a narrowing of the spinal canal (spinal canal stenosis).

There are several causes for a narrowing of the root outlet opening

By loss of height of the intervertebral disc and thus a smaller distance between the above and below of the disc vertebrae - but also by misalignments - can narrow the nerve outlet opening arise. Also spondylolisthesis, signs of wear, Calcification and arthrosis of the small vertebral joints are often responsible for a narrowing of the root outlet channel.

In neural foramen stenosis pain usually occurs when walking

The symptoms can be very different. They range from radiating pain to paralysis in the affected area. In detail: Back pain is not the focus of an isolated neural foramen stenosis, but the pain that radiates into the arms or legs - even on both sides. The pain most often occurs during exercise. When bending or sitting, you can feel relief, when stretching it comes to reinforcing the symptoms. In addition, the tingling sensation and numbness increase. Leg cramps, gait insecurity, paralysis of the arms and/or legs can also occur. It may cause bladder rectal disorders and/or potency disorders.

Diagnostics - X-rays, MRI and CT

Before treatment, a detailed history (in-depth interview with the patient), a physical and neurological examination and additional radiological examinations are necessary. Furthermore, a comprehensive examination with imaging techniques such as X-rays and MRI and CT follows. To recommend a meaningful, promising therapy to the patient, a very individual assessment is necessary. To make this possible, more and more doctors are working in an interdisciplinary team. These are specialists from different areas; orthopedic surgeons, radiologists, psychologists, neurologists and, of course, neurosurgeons.

Therapies - thanks to modern technology, complaints are alleviated and a better quality of life is created

After careful diagnostics, we decide which treatment is better for you and we create an individual treatment plan that aligns the measures which include: injections, physiotherapy and pain therapies. However, conservative therapies may be advisable in some cases if they are not feasible due to individual circumstances or if the stenosis becomes worse.
 
If conservative spinal canal stenosis therapies, such as injections or physiotherapy, do not show sufficient effect, or if there are discomfort, loss of strength, and bladder dysfunction, then we will consider microsurgery that will be a treatment of the stenosis by relieving the nerves by removing the calcifications and the thickened structures. Microsurgery allows us to expand the exit opening of the nerve root. Since neural foramen stenosis is often combined with spinal canal stenosis, the spinal canal will also be expanded. The expansion of the spinal canal is considered to be the most effective treatment method. 
 
Basically: Thanks to modern techniques, complaints are causally alleviated and life is facilitated with all its movements.
 
Usually one can count on a convalescence of a few weeks after the operation. Of course, recovery time depends on a variety of factors, including the age and general health of patients. In case of presence of additional instability, a stabilization / fixation operation could be taken under consideration.

Prognosis - no need to be afraid of the future!

However, you are required to do something for your pain-free or low-pain future.

One of the so-called magic agents is movement. Cycling is ideal – it gives to your nerves more space again. Stay active as the abdominal and back muscles support your spine. Untrained muscles, however, lead to tension and new back pain that have nothing to do with the stenosis.

Dr. med. Munther Sabarini

Author
Dr. med. Munther Sabarini
Specialist in Neurosurgery

Hans-Heinrich Reichelt

Co-author
Hans-Heinrich Reichelt
Chief Editor of Medizin für Menschen

The Avicenna Clinic in Berlin is always willing to help you

Since the year 2001, the Avicenna Clinic is based in Berlin. Our doctors have at least 25 years of international experience in their respective fields (neurosurgery, spinal surgery, anesthesia, and orthopedics).

If you have severe back pain, a herniated disc or a suspected herniation, please contact us using the following information:

Avicenna Clinic
Paulsborner Str. 2
10709 Berlin

Telephone: +49 30 236 08 30
Fax: +49 30 236 08 33 11
E-Mail: info@avicenna-klinik.de

You can call anytime, write an e-mail or fill out a callback form. Each patient then gets an appointment with a doctor of our clinic, who is a spine specialist (neurosurgeon). Based on MRI images (brought or made in our clinic) and on an in-depth examination, the doctor will discuss with you all the different therapy options or possibly surgery. You can also use our specialists only to obtain a (second) opinion.

If you decide to undertake your therapy and/or surgery in Berlin, we would want to make your stay as pleasant as possible. In our clinic, you are at the center of our attention! You can expect state-of-the-art equipment in all areas - from the operating room to the patient bedroom.

The latest, gentle, minimally invasive treatment procedures are the focus of our clinic. Together we try to find a suitable treatment for your complaints. The actual therapy takes place only after a detailed discussion with the patient, examinations and the diagnostics.

For us, as important as medical care, it is the commitment we take to guarantee our patients a high level of personal care that can, in turn, ensure them a comfortable stay.

During the period of inpatient stay our team of nurses will take care of you 24 hours a day. They also offer services in several foreign languages, including English, Russian, Polish, Turkish, Spanish, Italian, Arabic, Bulgarian and French. We care not only about your safety but also your needs, respecting traditions and religions.

Our team is made up of a group of highly qualified specialists who work together to guarantee you a quick recovery.