Lumbar Foraminal Stenosis

An Overview of Lumbar Foraminal Stenosis
(Collapse of the Lumbar Spine)

Lumbar foraminal stenosis (collapse of the lumbar spine) is very similar to lumbar spinal stenosis in the sense that it involves the narrowing of an area within the spinal canal. The individual nerves will exit through a small hole in the side of the spine in between the two vertebrae. This nerve root exiting occurs at every level in the spine. Do not confuse this condition with lumbar central stenosis where all the nerves in the canal are compressed. With lumbar foraminal stenosis, the compression is at the exit hole of the nerve (the foramen). Since the exiting hole is known as the foramen, narrowing of this hole is called foramenal stenosis (obviously- stenosis means narrowing). The stenosis is caused by the clogging of this nerve opening with bone spur, debris from degenerative facet disease and/or unilateral collapse of the disc (foramenal collapse).

Biomechanics

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).

Symptoms of Lumbar Foraminal Stenosis

The most common symptom associated with collapse of the lumbar spine 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.

Treatment of Lumbar Foraminal Stenosis

Non-Surgical

Most of the time, this lumbar foraminal stenosis 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.

(Click to Enlarge Image) This diagram shows the angular collapse that can occur with asymmetric wear of the spine. The foramen that the nerve exits from is substantially narrowed by this collapse and nerve pain can occur with walking.

(Click to Enlarge Image) This CT scan demonstrates the narrowing of the nerve hole (foramen) from a bone spur. The arrow points to the foramen with the most significant narrowing but the one below is also narrowed by spur.

(Click to Enlarge Image) This illustration demonstrates what happens to the size of the foramen with backwards bending. The foramen becomes smaller with extension. If there is narrowing of this foramen, the nerve that exits the foramen can become compressed. Sitting and bending forward will increase the size and simply standing and walking will narrow it.

Are you suffering from symptoms of lumbar foraminal stenosis?

Would you like to consult with Dr. Corenman about your condition?
You can set up a long distance consultation to discuss your
current X-rays and/or MRIs for a clinical case review.

REQUEST A SECOND OPINION

(Please keep reading below for more information on this condition.)

Surgical

If the compression is not associated with a collapse of the foramen, a simple microsurgical foramenotomy can be performed to treat a collapse of the lumbar spine. 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 (foraminal 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, or to visit with a spine specialist and back doctor in the Vail, Aspen, Denver and Grand Junction, Colorado area to discuss collapse of the lumbar spine, please contact the office of Dr. Donald Corenman.

Related Content

Donald Corenman, MD, DC

Average rating:

81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

Submit your review
First Name, Last Initial:
Email:
Review Title:
Rating:	1 2 3 4 5
Review:

Check this box to confirm you are human.
Submit Cancel

An Overview of Lumbar Foraminal Stenosis (Collapse of the Lumbar Spine)