Symptoms, diagnosis, treatment of foraminal stenosis
Foraminal stenosis – narrowing of the spinal canal at the level of exit of the nerves from the intervertebral foramina. Most often the compression is caused by bony growths osteophytes (osteochondrosis or spondylosis of the spine) or the accumulation of inflammatory fluid.
The Second name pathology – lateral stenosis, which reflects the localization of compression (in the lateral part of the spinal column). According to the statistics, the majority (75%) of foraminal stenosis occur in the lumbar spine. The remaining 25% are evenly distributed between the cervical and thoracic divisions.
The Clinical manifestations of the disease in 80% of people due to the sciatic nerve. He is one of the largest nerves of a person and passes through the gluteal region to the lower limbs.
signs of pathology
foraminal Stenosis – medical definition from the Latin "foramen" is "hole". The narrowing of the intervertebral foramen leads to the infringement of the nerve roots emerging from the spinal canal. Such a condition is dangerous with serious consequences and disabilities.
What signs indicate the presence of foraminal narrowing:
- Punctuating leg sharp pain in the calf when walking. There are several clinical forms of the symptom, which depend on the location of the infringement (koudounia, spastic, dystonic);
- Paroxysmal reaction of the peripheral nervous system. During intense exercise in humans can be taken away for hands or feet. The symptom was transitory stenosis of 1 degree and disappears in the supine position;
- discomfort in the form of paresis and paralysis. The state is formed due to violations of the innervation of the muscular system. Against this background, narrowing of the intervertebral slit may be formed persistent compression of the nerve, which over time leads to the appearance of seizures;
- Neurapraxia – the formation of a persistent neurologic deficit after spinal column trauma. For example, when falling on a straight arm in humans may occur immobilization of the lower extremities. Symptoms arise due to the presence of strangulated lumbar nerve. Trauma is only a precipitating factor for the formation of complications of the disease. They can also be observed when rough turning or flexion of the spine;
- Muscle-dystonic disorders are formed in the presence of multiple foci of osteofibrosis with painful sensations in the field of interspinous and paravertebral cracks. Around the joints, condyles, and in the projection of the sacroiliac joints are observed when the disease hypertonic muscle fibers. If untreated, muscle spasms will generate an additional impairment of nerve fibers which pass in their column.
For example, very often together with degenerative disc disease sciatica occurs due to piriformis syndrome (increased tone with the sciatic nerve).
A Skilled neurologist is able to identify the first signs of foraminal stenosis and to appoint adequate treatment. If the disease will progress, even surgery will not eliminate the disability. This pattern is observed in more than 70% of people with this pathology, despite the fact that foraminal nerves is considered to be a benign disease in comparison with Central spinal stenosis.
The Symptoms of foraminal stenosis are observed narrowing of the hole by more than 1/3.
what are the symptoms receives a diagnosis of foraminal stenosis of the spine:
- the Typical symptom is pain in the gluteal muscles. Occur when the sciatic nerve. Increase when walking and decrease when standing;
- Weakness in limbs
- the Lack of tactile and pain sensitivity of the skin (paresthesia).
The Pathological symptoms are worse when changing body position, bending anteriorly.
Increased pain when bending forward is a specific marker of spinal pathology. If the infringement of nerve trunks in the intervertebral holes people can climb stairs, ride a bike without pain in the lower back, buttocks and lower extremities. However, when walking on a flat surface, the descent and he develops a strong pain.
These symptoms are due to the specific localization of nerve compression in the crevices between the vertebrae. Anatomically when bending forward they are narrowed, which increases the compression. Upright foraminal openings return to normal, therefore the pain disappears.
The Diagnosis of foraminal narrowing of the spine is exposed on the basis of the following clinical data:
- examination of the patient, and test neurological reflexes
- Detection of violations of skin sensitivity and muscle weakness in the study by a neurologist
- Radiography and magnetic resonance imagingof the vertebral column.
If there is suspicion of concomitant stenosis of the spinal canal and lateral contraction, is applied myelography (contrast study of subarachnoid space of the spine).
When bending the leg the lumen of the spinal canal is reduced. This is based on the Lasegue test: the patient in the supine position bent legs in the knee joints, and he has lower back pain.
A Negative Lasegue test is not evidence of absence of pathology. The disease progresses gradually. With a slight decrease in the size of the intervertebral gap in the initial stages may not have neurological symptoms. To expose the diagnosis it is possible when receiving data of clinical and instrumental methods (x-ray, CT, MRI) with respect to the existence of narrowing of the foraminal openings on one or more levels of the spinal column.
Treatment of foraminal stenosis include conservative and operative methods. Drug therapy the disease is carried out by the following methods:
- Healthy lifestyle
- Injection of epidural drugs.
Physiotherapy when foraminal stenosis is performed to strengthen the muscular frame back, which would be required to maintain the height of the intervertebral gaps. Thus, it is possible to prevent occurrence of pain.
Normalization of lifestyle when the disease involves the exclusion from the diet of fatty and spicy foods. It is necessary to use a large number of vitamins and minerals from natural plant products. They improve blood circulation and help to fight inflammatory and edematous lesions in the soft tissues of the vertebral column.
If pain persists pharmaceutical preparations, you can apply steroid injections of funds into the subarachnoid space at the level of compression of a nerve root. The effectiveness of this therapy achieves 50%, but because of complications it is not recommended to apply it more than 3 times a year.
Surgery for foraminal narrowing is performed when vertebral instability or when conservative treatment did not bring positive results. Its goal is decompression of the nerve fibers. The surgery is performed through a small access (4-5 cm), which creates severe cosmetic defects of the skin.
In Europe developed by the installation of interspinous spacers. They involve the installation between the spinous processes of the vertebrae in the area of damage of special products to prevent lowering of the intervertebral gaps. With the help of these products expands the intervertebral gap, which eliminates the nerves and the appearance of pain.
The Introduction of the spacers relates to low-traumatic operations. The device is installed through a small skin puncture using the puncture under the control of digital x-ray installation.
When intervertebral hernia perform this surgery will not bring relief to the patient, because the bulging disc can compress the nerve roots, despite the increased foraminal slit. To eliminate the pathology, in this case applied neurosurgical decompression with removal of pathological lesions and bone growths in the cavity of the spinal canal.
Traumatic or Degenerative lateral stenosis is not related to the number of light pathology, treatment which can be performed at home. The disease requires early detection and treatment in a specialized hospital. The only way to prevent disability.