Neural foramina are small canals at every level of the spine through which nerves leave the spinal cord and go to the limbs and other parts of the body. Narrowing of this canal is called foramina stenosis. Narrowing may be caused by bone spurs, a herniated or bulging disc, arthritis, ligament thickening or enlargement of a joint in the spinal canal. This puts pressure on the nerve roots causing symptoms that include pain, muscle weakness, muscle spasms, cramping, numbness, and tingling. The symptoms may be felt in the neck, back, shoulders, arms, hands, legs, buttocks, or feet depending on the position of the affected foramen.
Diagnosis
To diagnose spinal stenosis, your doctor may ask you about signs and symptoms, discuss your medical history, and conduct a physical examination. He or she may order several imaging tests to help pinpoint the cause of your signs and symptoms.
Imaging tests
These tests may include:
X-rays. An X-ray of your back can reveal bony changes, such as bone spurs that may be narrowing the space within the spinal canal. Each X-ray involves a small exposure to radiation.
Magnetic resonance imaging (MRI). An MRI uses a powerful magnet and radio waves to produce cross-sectional images of your spine. The test can detect damage to your disks and ligaments, as well as the presence of tumors. Most important, it can show where the nerves in the spinal cord are being pressured.
CT or CT myelogram. If you can't have an MRI, your doctor may recommend computerized tomography (CT), a test that combines X-ray images taken from many different angles to produce detailed, cross-sectional images of your body. In a CT myelogram, the CT scan is conducted after a contrast dye is injected. The dye outlines the spinal cord and nerves, and it can reveal herniated disks, bone spurs and tumors.
How foraminal stenosis is treated?
As beforementioned causes for the stenosis, the management plan differs. If the main cause of your foraminal stenosis is bone spurs, the most appropriate management is open surgery or endoscopic foraminoplasty. If the cause was thickening of ligamentum flavum then the most appropriate management is the claudicare or endoscopic foraminoplasty. Your spine physician will discuss which method is most appropriate for you after seeing the scans requested.
Claudicare:
its technique is much like the disc fx technique but instead of removing a part from the herniated disc, claudicare removes the thickened part of the ligamentum flavum.
Endoscopic foraminoplasty:
It’s a minimally invasive procedure which is mostly alike to endoscopic discectomy but with other specialized tools in removing the bony spurs or the thickened ligamentum flavum. The main difference between the endoscopic foraminoplasty and claudicare is that we can see what we are doing with a camera.
Advantages of both Endoscopic foraminoplasty and Claudicare
Both endoscopic foraminoplasty and claudicare are minimally invasive procedures and their benefits include:
-Small incision and less scarring
-No or little blood loss
-Does not cause spinal instability
-Usually done under local anesthesia, thus the risks of general anesthesia are avoided
-Can be performed in medically high-risk patients and obese patients
-Can be performed in multiple levels in the same procedure
-Physical therapy can begin the same day as the surgery
-Less post-operative pain
-Less risk of infection
-Both Claudicare and Endoscopic foraminoplasty are day-cases in which the patient gets back home on the same day of the operation
Endoscopic foraminoplasty is a safe and effective surgical option for treatment of foraminal stenosis.
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