Thoracic Foraminal Stenosis
In the thoracic spine (mid back, upper back) foraminal stenosis describes narrowing of the passageway in the spinal joints where the spinal nerve exists. In the thoracic spine, these nerves control the sensation and function of the arm, chest, truck and even the sensation of the upper buttock region. Bone spurs, disc herniation or a pathological process that affects bone, such as a tumour, can cause thoracic foraminal stenosis.
How does thoracic spinal stenosis come about?
Thoracic spinal stenosis is classified in two ways:
- Primary. Caused by congenital abnormalities (born with the disease) or a postnatal disorder.
- Secondary (acquired stenosis). Results from degenerative changes or due to local infection, trauma or surgery. The former of this subtype is most common.
Thoracic foraminal stenosis can involve the central canal (where the spinal cord runs through), lateral recess (the area just lateral to the central canal), foramina (where the spinal nerve exists the spine) or any combination of these locations.
- Central canal stenosis is caused by a decrease in the diameter of the canal due to loss of intervertebral disc height with or without bulging of the intervertebral disc, and hypertrophy (abnormal growth) of the facet joints (joints located at the back of the vertebrae) and the ligamentum flavum (a large, thick ligament covering the spine). Fibrosis (thickening) is the main cause of ligamentum flavum abnormal growth and is caused by accumulation of mechanical stress, such as sustained bending forward under load.
- Lateral recess stenosis can result from a decreased disc height, facet joint hypertrophy and/or spinal bone spurs.
- Foraminal stenosis results from a combination of disc space narrowing and overgrowth of structures in front of the facet joint capsule or spinal bone spurs protruding into the foramen along with a herniated disc or bulging disc that compresses the exiting nerve root against spinal bone.
Thoracic foraminal stenosis risk factors
Most of the risk factors for thoracic foraminal stenosis include those related to ageing, as it is primarily a degenerative disease. Some include:
- Excessive body weight, which increases the load placed on spinal structures
- Older age (>50 years old)
- Family medical history (hereditary factors, such as tumours)
- Past injury history (for example, repetitive trauma to the spinal discs or infections)
- Current occupation and pastimes (mostly related to sustained poor postures and high-impact sports)
Symptoms of thoracic foraminal stenosis
The symptoms of thoracic foraminal stenosis range from nothing to significant pain and dysfunction. It is likely that the intensity of the symptoms will be determined by the amount of compression of the thoracic spinal nerves but it doesn’t always correlate as such. Pain is common at the level of the compression and down the path of that nerve (dermatome). In advanced cases, with marked compression, muscle weakness and loss of function can occur however this is rare. Some of the most commonly experienced pain and discomfort includes:
- Local and traveling pain
- Burning sensation
- Muscle weakness
- Numbness and tingling
- Loss of fine motor skills
- Limited mobility
Treatments of thoracic foraminal stenosis
Chiropractic (conservative management) is usually enough to manage symptomatic cases of thoracic foraminal stenosis. If the narrowing is significant and causes significant compression and irritation to spinal nerves, it is likely that one of our chiropractors will send you for a surgical opinion. This is not common. Chiropractic management for thoracic foraminal stenosis would include joint therapies such as manipulation, mobilisation, active and passive repeated movement therapy and strengthening exercises. A review of occupational, recreational and individual factors would also play an important role in managing thoracic foraminal stenosis. Only in cases where mechanical treatments don’t work (mechanically unresponsive) would a chiropractor send for surgical review.
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