The biomechanics are very easy to understand. The nerve hole is made up of a clam shell of the vertebra above and the vertebra below. This hole enlarges with bending forward and narrows with bending backwards and to the side of the hole (right sided hole will narrow with right lateral bending). If the hole is clogged up or the nerve root is swollen (which can happen to a pinched nerve), the nerve will be compressed with standing and walking and relaxed with sitting forward, crouching and leaning over a counter (or shopping cart).
The most common symptom associated with lumbar foraminal stenosis/collapse is unilateral or one-sided buttocks or leg pain with standing and walking. This pain goes away with sitting forward, crouching or leaning over a counter (or even a shopping cart). When the pain occurs, it normally starts in the buttocks and with prolonged standing, will radiate down the front or rear of the leg. It can be a pins and needles pain or just numbness.
Most of the time, this lumbar foraminal stenosis/collapse is not dangerous. That is, when the nerve is compressed and pain occurs, the individual can simply lean forward to "get off the nerve". Permanent damage to the nerve is normally less that 5%. Treatment includes physical therapy and a "flat back" program, medications and spinal injections. Education to avoid certain activities and sports that cause extension is important.
If the compression is not associated with a collapse of the foramen, a simple microsurgical foramenotomy can be performed. The recurrence rate can be as much as 10-30% depending upon the anatomy. There are cases where the vertebra is so degenerative (very little motion), a foramenectomy can be used with a better success rate. If the vertebra is collapsed unilaterally on the side of the stenosis (foramenal collapse), a TLIF (Transforaminal Lumbar Interbody Fusion) may be necessary to free the nerve and prevent future impairment to the nerve.
For more information on lumbar foraminal stenosis/collapse or for additional resources on conditions and treatments of the spine, contact Dr. Donald Corenman at 888-888-5310.
Lower Back - Lumbar Spine
- Back Pain in the Child Athlete
- Degenerative Scoliosis of the Lumbar Spine
- Degenerative Spondylolisthesis (Spondylolysthesis)
- Ganglion Cysts
- Herniated Disc Lumbar Spine
- Isthmic Spondylolisthesis (Slipping of a Vertebra Because of Fracture)
- Lateral Recess Stenosis
- Lumbar Degenerative Disc Disease or Low Back Pain
- Lumbar Degenerative Facet Disease
- Lumbar Foraminal Stenosis / Collapse
- Lumbar Spinal Stenosis (Central Stenosis)
- Lumbar Spine Instability
- Pars Fracture
- Spondylolysis in Children