Neural foraminal stenosis is a common condition that can cause symptoms referred to as a pinched nerve. The neural foramen (spinal foramen) are small holes on the sides of the backbone that are passageways for the spinal nerves. The holes can get tight or narrow due to conditions like arthritis, inflammation, or prolonged bad posture.

Pinching (compression) of the nerves causes diminished sensation, tingling, pain, or weakness. Some treatments can include physical therapy, oral anti-inflammatory medication, injections into the spinal area, or surgery.

Types of Neural Foraminal Stenosis

Your backbone is also called the spine, spinal column, and vertebral column. The vertebral column comprises individual vertebral bones with spinal discs between each bone. Your spinal cord goes through a canal in your spine.

Between each pair of vertebrae are a right and a left neural foramen where the spinal nerves at that level exit to the right and left sides of your body.

Your spine runs from the base of the skull down to your tailbone. Its sections are called the cervical spine, the thoracic spine, and the lumbar spine. Neural foraminal stenosis can occur at any spinal cord level, but it’s most common in the lumbar spine and least common in the thoracic spine.

Cervical Foraminal Stenosis

Your cervical (neck) spine is the upper area of the spine. Cervical spine foraminal stenosis can cause neck pain and pain, tingling, diminished sensation, or weakness down the arm along the path of the nerve on one side of your body.

Thoracic Foraminal Stenosis

Your thoracic spine is the area of the backbone in your mid-back. Thoracic spinal foraminal stenosis is not as common as foraminal narrowing of the cervical spine or lower back. Symptoms can involve pain or tingling in the mid-back.

Lumbar Foraminal Stenosis

Your lumbar spine is the lower part of your spine. Lumbar spine foraminal stenosis is more common than foraminal stenosis in other areas of the spine. Symptoms include back pain and pain, numbness, tingling, or weakness down one leg.

Symptoms

Spinal foraminal stenosis may cause symptoms of a pinched nerve or may cause pain at the location of compression or irritation of the nerve. Symptoms occur along the path of the affected nerve. Each spinal nerve starts at the spinal cord and has a specific path down one side of the body.

Common symptoms include:

• Decreased sensation (numbness)
• Tingling
• Pain
• Weakness

You can have one or more of these symptoms, and the symptoms are often more noticeable as the foramen becomes smaller and compresses the spinal nerve more tightly. 

Causes

Usually, neural foraminal stenosis happens gradually as a result of inflammation or degeneration of the spinal structures—bone, intervertebral discs, and connective tissue.

Inflammation and degeneration of the spine can cause one or more spinal foramina to narrow, irritating or compressing the spinal nerve. 

Common causes include:

• Repetitive motions that contribute to degenerative changes 
• Prolonged positions that disrupt your spine’s alignment 
• Trauma
• Arthritis
• Inflammatory disease, such as lupus
• Cysts or growths (noncancerous or cancerous) in the area of a neural foramen

How It’s Diagnosed 

Neural foraminal stenosis is often diagnosed based on a combination of symptoms, a physical examination, and diagnostic testing. Symptoms that correspond to one or more pinched nerves may be an indication that you could have neural foraminal stenosis.

Physical exam signs can include diminished reflexes, diminished sensation, hypersensitivity, and weakness in a pattern that points to disrupted function of a spinal nerve.

Diagnostic tests that can help in diagnosing neural foraminal stenosis include:

• Spine X-ray: Spine X-rays evaluate for other causes of symptoms, such as fractures or other bone abnormalities. Nerves cannot be seen on X-rays.
• Spine magnetic resonance imaging (MRI): MRI shows the neural foramina and the nerves passing through them as well as the vertebrae, spinal cord, and discs. It can show the narrowing of a neural foramen and the compression of a nerve.
• Electromyography (EMG): This diagnostic procedure measures muscle function and may detect changes in how your nerves stimulate your muscles. It may show issues with muscles, the nerves that signal your muscles, or communication between the nerves and muscles.
• Nerve conduction velocity (NCV) study: This diagnostic procedure can assess how well one or more of your nerves is functioning and may detect patterns indicating a pinched nerve. 

Treatment 

There is a range of effective therapies for neural foraminal stenosis. You and your healthcare provider can discuss treatment options. The best treatment for you depends on factors such as the severity of your symptoms, how much it’s affecting your abilities and quality of life, its underlying cause, and whether you have one or many areas of spinal foraminal narrowing. 

Nonsurgical Treatments

Your personalized treatment plan can involve medication, exercises, injections, or surgery. 

Anti-inflammatory medications can reduce inflammation that’s narrowing the spinal foramen. Medication can help reduce your pain or other unpleasant sensations. You might be prescribed medication to take by mouth, or you may need to have medication injected near the area of foraminal stenosis.

You might also work with a physical therapist, who can assess your movements and tailor an exercise treatment plan for you. 

At-Home Management

Your healthcare provider or a physical therapist might give you instructions for exercises to do on your own at home. Additionally, they may provide you with recommendations for better posture or sleep support to help improve your comfort or prevent further narrowing. 

Surgical Options With Severe Foraminal Stenosis

Sometimes surgery can be beneficial for the treatment of neural foraminal stenosis. A surgical procedure can help widen the area. Surgery might be an option for you, but it’s not always the right approach. 

You can discuss the risks and benefits of surgery with a surgeon as you decide whether it is right for you. 

Outlook and Chronic Pain Management 

The outlook for spinal foraminal stenosis varies, and you can discuss your situation with your healthcare provider.

The symptoms are often manageable with medication and physical therapy. In addition to providing relief of your existing symptoms, treatment can help prevent your condition from getting worse. 

In some cases, nerve damage is permanent, and you might have long-term pain, diminished sensation, or weakness. If your pain or weakness is disabling, you might need a walker to get around.

How to Prevent Neural Foraminal Stenosis

Though there’s no way to completely eliminate the likelihood of developing neural foraminal stenosis, there are some things you can do to lower your risk. 

How to reduce your risk of spinal foraminal stenosis includes:

• Maintain a healthy posture while working. 
• Avoid neck or back injuries by exercising regularly to build strength gradually. 
• Try to keep good form when you exercise. 
• Sleep in a comfortable position with a supportive mattress and pillow. 
• Take medication as directed if you have an inflammatory disease. 
• Get medical attention if you develop pain or stiffness in your back or neck. 

When to See a Provider

You need to get medical attention for symptoms of spinal foraminal narrowing. Early treatment also gives you a better chance of preventing the worsening of your condition. 

If you have new or worsening pain, unusual sensations, decreased sensation, or trouble with movement, make an appointment to see a provider.

Summary

Neural foraminal stenosis is a common condition that causes symptoms of a pinched nerve. You might also have signs on physical examination, and diagnostic tests can help assess the level and severity of foraminal narrowing.

This condition can range in severity, often improving with medication, exercise, and lifestyle adjustments. Sometimes a surgical procedure may relieve pressure on the nerve.

Tips to help prevent spinal foraminal stenosis include maintaining a healthy posture while working or during leisure activities, having good back and neck support when you sleep, and taking medication as directed if you have an inflammatory condition.