Foraminal Stenosis Diagnosis & Treatments
How Is Foraminal Stenosis Diagnosed?
Accurate and thorough diagnosis is key to selecting the best treatment options. The following is part of a comprehensive diagnostic workup:
- Medical history – Assessment of symptoms, previous treatments and care.
- Physical examination – A careful examination by a spine specialist for limitations of movement, problems with balance, and pain. The examination should also cover loss of reflexes in the patient’s extremities, muscle weakness, loss of sensation, or signs of spinal cord damage.
- Diagnostic tests – Generally, plain x-ray films are taken, which allow the physician to rule out other problems, such as infection. CT scans and MRIs are often used to give a three-dimensional view
What are the Treatment Options For Spinal and Foraminal Stenosis
As with any spinal condition and depending on the severity of the symptoms, conservative care should always be suggested first before surgical intervention.
- Medications: anti-inflammatories, muscle relaxers, and, on rare occasions, narcotic medications
- Alternating heat/cold therapy during the first 24-48 hours
- Physical therapy exercises: including stretching, massage, and strengthening
- Epidural steroid injections are used two-fold: first, to relieve inflammation of the affected spinal nerve, and secondly, to diagnostically confirm the affected level, from which the pain is originating.
Least Invasive Procedures for Foraminal Stenosis
When conservative care is exhausted, and a patient is still in pain, surgery is a logical step to relieve the pain. Traditionally, central and lateral recess stenosis surgery is performed in an open procedure with a large incision in the skin. A laminectomy and/or facetectomy are performed to release the pressure on the spinal cord. Unfortunately, this technique is invasive and leads to significant post-operative pain and lengthy recovery. With innovation and advances in technology, a less invasive endoscopic technique has been developed to address these painful conditions, such as foraminal stenosis.
- Endoscopic Foraminalplasty: Unlike traditional open surgery, a small ¼ inch incision is made in the skin. The back muscles are spared and only dilated in order to gain access to the surgical site. The physician uses a working channel endoscope that allows for water and instruments to pass through the scope with an HD camera attached that provides a detailed view of the anatomy and the spinal cord. The patient is under conscious sedation- alert and comfortable throughout the procedure. No general anesthesia is needed and this lowers complication risk for
Minimally Invasive Spine Surgery Options for Foraminal and Spinal Stenosis
- MIS Laminectomy – Some or all of the lamina, or posterior part of the vertebra and spinal ligament are removed to free the nerves. Sometimes a spinal fusion is incorporated with a laminectomy due to spinal instability.
- Foraminotomy – The foramen or openings on the sides of the vertebra, through which spinal nerves exit the spinal column, is removed to reduce pressure on the nerve. Sometimes a spinal fusion is incorporated due to spinal instability after decompressing of the foramen.
- MIS Microdiscectomy – Is a surgery to remove herniated disc material that is compressing a nerve root or the spinal cord. This surgery is usually done as a microdiscectomy using a microscope or surgical loupes. Before the discectomy is done the surgeon removes a small piece of bone called the lamina from the targeted intervertebral body in order to access the herniated disc. This bone resection is referred to as a laminectomy or laminotomy. A microdiscectomy can be done as an open or with a tubular retractor.
- MIS TLIF Spinal Fusion – Two or more vertebrae are immobilized with surgical rods and screws. Bone graft is placed in the space between the vertebrae to encourage growth of the bones together.
How Long Is The Recovery?
Our Least Invasive Procedure patients’ can begin getting out of bed one hour after surgery and go home shortly afterwards. There will probably be some pain after the procedure and is usually localized to the incision site. Activity is gradually increased and patients are typically able to return to work around a week to two weeks. Keep in mind just because there is less or no pain, always consult your physician before beginning any physical work.
Our Minimally Invasive Spine Surgery patients’ post-operative recovery is much longer and may involve overnight stay in the hospital. Once your pain in under control you can go home. Dr. Rodriguez will give you medication to control your pain while you recover at home.
At home, you will need to continue to rest. You will be instructed on how to gradually increase your activity. You may still need to take the pain medications for a while. However, pain and discomfort should begin to reduce within a couple of weeks after surgery. The doctor will discuss with you other techniques for reducing pain and increasing flexibility before you leave for home. The doctor will also discuss with you a time frame for when you can resume basic activities such as walking, driving and light lifting, and when you can return to more advanced activities such as physical labor, sports and yard work.