Neuralforaminal Stenosis Treatment

If you have been diagnosed with neuralforamenal stenosis (which is a narrowing of one or more openings at the side of the vertebral column which are known as foramen) chances are you've experienced symptoms of radiculopathy. Radiculopathy occurs when a spinal nerve root is imposed upon (called impingement or encroachment.)

Man sitting on bed at night holding his lower back in pain
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Radiculopathy is common in cases of degenerative arthritis and herniated disc. Symptoms generally manifest as pain, tingling, numbness and/or weakness going down the affected extremity. For reference, sciatica is one form of radiculopathy.

But neuroforaminal narrowing may incur other symptoms, as well. These may include muscle spasms, sharp pain, burning sensations, and possible weakness and/or diminished sensations, according to Allen Wilkins, MD, of Manhattan Physical Medicine and Spine.

Neuralforamenal Stenosis Treatment Options

Whew! That sounds like a lot to deal with! You may be wondering if is there something you can do to feel better and “stay in the game” of life's responsibilities after a diagnosis of neuralforamenal stenosis.

Yes, there is. And you likely won't need surgery for it.

"Ninety percent of patients with neuroforaminal narrowing improve their symptoms with some form of non-operative management," says Dr. Ali Bydon, Associate Professor of Neurosurgery, Director of Spinal Column Biomechanics and Surgical Outcomes Laboratory at Johns Hopkins Medical School and Clinical Director of Spine Surgery at Johns Hopkins Bayview Medical Center.

Bydon says that for neuralforamenal stenosis, the first-line treatment consists of pain medications and/or non-steroidal anti-inflammatory drugs. In addition to this, you may go to physical therapy for stretching and strengthening exercises that target neck or back muscles. Your PT treatment may include heat, ice and/or ultrasound, as well.

And finally, Bydon points out that cognitive therapy, for example, talk therapy and/or relaxation therapy, as well as therapeutic massage may also help alleviate symptoms.

Dr. Robert Bray, a neurosurgeon at the DISC Sports and Spine Center in Marina del Rey, California, adds that physical therapy may include work on your posture. Neuroforamenal stenosis is often affected by bad posture in the neck, he says. He goes on to explain that rounding of the upper back increases the extension of the neck which in turn further narrows the neuroforamin in that area.

“Exercises that correct rounded shoulder posture to a more normal alignment decrease foraminal stenosis," he says, adding that the traditional methods of physical therapy strengthening can be extremely useful when coupled with corrective posture exercises.

Bydon says that another option for relieving pain related to neuralforaminal narrowing and its accompanying nerve root compression are epidural steroid injections. The goal of this kind of injection is to decrease inflammation and/or to numb your nerve root. The soothing medication is injected around the nerve root, usually, with the aid of fluoroscopy or other image guiding technology, he informs me.

Bray agrees and adds that if you have an acute flare-up, your nerve will likely swell. This means that it is passing through a hole (the foramen) that is too small. Injecting steroid medication around the nerve root reduces the swelling, he says. And when you combine this treatment with a physical therapy program designed for developing good posture, you may well have a recipe for pain relief of moderate level neuralforamenal stenosis symptoms, he comments.

The Bottom Line

If you try medications and/or physical therapy for six to eight weeks without pain relief, it may be time to consider surgery, Bydon says.

Bydon suggests seeing a spine surgeon if you experience sensory changes and/or weakness early on in the course of your neuralforamenal stenosis.

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  • Email Interview. Bray,, Robert S. Jr., MD. DISC Sports & Spine Center. Marina del Rey, CA. December 2013.
  • Email Interview. Bydon, A., MD. Associate Professor of Neurosurgery, co-Director of Neurosurgery Medical Student Education, Director of Neurosurgery Undergraduate Student Education, Director of Spinal Column Biomechanics and Surgical Outcomes Laboratory at Johns Hopkins University, Clinical Director of Spine Surgery at Johns Hopkins Bayview Medical Center. December 2013.
  • Email Interview. Wilkins, A., MD. Manhattan Physical Medicine and Rehabilitation. New York. December 2013.

By Anne Asher, CPT
Anne Asher, ACE-certified personal trainer, health coach, and orthopedic exercise specialist, is a back and neck pain expert.