Cervical foraminal stenosis

By: Peter F. Ullrich, Jr., MD
November 2, 2006

Types of pain from cervical stenosis (foraminal stenosis)

Foraminal stenosis (narrowing of the cervical disc space) may arise without any disc herniation. The majority of symptoms are usually caused by one nerve root on one side. Typically, the condition is characterized by the following:

• The pain develops slowly (versus acute pain)

• The pain may develop over many years

• The pain is not continuous

• The pain is related to an activity (such as bicycle riding) or position (such as holding the neck in an extended position)

The condition is caused by enlargement of a joint (the uncinate process) in the spinal canal and can be confirmed by either an MRI scan or a CT with myelogram.

Treatment of pain from foraminal stenosis

Unlike many other back or neck conditions, most conservative treatments for foraminal stenosis (such as pain medications or other modalities) are unlikely to be of much benefit. Traction may provide some pain relief.

Most often, patients choose either activity modification or back surgery to relieve pressure in the nerve root from foraminal stenosis.

• Activity modification for foraminal stenosis. If patients are not unduly troubled by foregoing a few activities and are not in a great deal of discomfort, choosing to live with the condition is a reasonable option. Delaying or avoiding back surgery is not dangerous, and back surgery may always be considered at a later date.

• Back surgery for foraminal stenosis. This usually includes an anterior cervical discectomy and spine fusion in which the disc is removed and the disc space is distracted open to allow opening of the foramen and give the nerve root more room. A bone graft is left in the disc space to keep in distracted. The surgical procedure is reliable in terms of pain relief and has minimal morbidity (such as postoperative pain). The back surgery can usually be done with an overnight hospital stay and then takes about 2 to 6 weeks to return to normal activities.