Treatment for Foraminal Stenosis

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lumbar spine x-ray

There are several treatment options for Foraminal Stenosis.  Conservative treatments are the first port of call, and if those fail, surgery is an option.

Non-Surgical Treatment for Foraminal Stenosis

Adjusting your activities and lifestyle.  When stenosis is severe, walking is painful, and most people can’t walk very far.  Assistive devices like canes and walkers can help, or leaning on a shopping trolley.

Exercise.  Specific exercises from a physical therapist can help maintain and increase function. Flexing forwards can increase the space in the foramina and help release impinged nerves, and therefore reduce pain.  Because it can be such a painful condition, the temptation is to become inactive, to avoid the pain.  However, this will only lead to further pain and disability. Stationary cycling is often a good option, because the forward leaning position on the bike helps with the pain of stenosis, so the patient can retain fitness and strength.

Non-steroidal Anti-inflammatories.  Inflammation plays a large part in stenosis pain, from bone on bone and bone spurs forming, and impinging nerves.  Anti-inflammatory medications can help relieve some of this inflammation and thus relieve some pain.

Epidural injections.  Steroids can be injected directly into the epidural space (the space within the spinal canal between the lamina and the sac around the nerve root), along with a local anaesthetic.  Steroids are powerful anti-inflammatory medications and these injections can give several weeks or even months of relief.

Surgical options for Foraminal Stenosis

Surgery is only performed as a last resort, after all non-surgical options have failed, and the patient is experiencing daily, severe pain.

Lumbar Laminectomy and decompression

This is the most common surgical treatment, and it has an 80% success rate.  Patients often can return to all activities and a pain free life after this procedure.

Lumbar laminectomy is designed to remove a small portion of the bone over the nerve root and/or disc material from under the nerve root, which gives the nerve root more space, relieves the entrapment and cause no more pain.

The procedure usually involves staying in hospital for three or four days, and walking is encouraged as soon as possible after the procedure.   Patients should avoid excessive bending, lifting or twisting initially for the first six weeks, but should then be able to return to normal activity.

Success rates of lumbar laminectomy and decompression.

The literature quotes 70-80% of people have significantly reduced never pain and/or sciatic pain after Lumbar Laminectomy and Decompression, and may return to healthy, active lives.

Lower back pain, however, is NOT relieved by this surgery.  Degenerative arthritis of the facet joints is the original cause of foraminal stenosis, and the cause of the lower back pain.   Because this surgery does nothing to treat the arthritic and inflamed facet joints, the arthritic lower back pain will remain.

 

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