Foraminal Root Compression Syndrome

A variation of the spinal stenosis problem occurs when there is compression of an isolated root in a spondylotic foramen. Patients present much with similar complaints as in acute disc herniation, but the time course is protracted and the onset has usually been gradual. Patients complain of sciatica or femoral pain in the accepted distribution of a single root. Sometimes root involvement is bilateral and occasionally more than one root on one side is affected. However, the syndrome is not of claudication but of ongoing root compression. That is, the pain tends to be constant, although it is often exacerbated by activity, being upright and axial loading. The associated reflex, motor and sensory changes relate to the individual root. A positive straight-leg raising is unusual, which is different, than the tension sign of the acute disc herniation. Diagnosis is made by MRI and CT, which visualize the neural foramina and the compression of the nerve root.

There is little evidence that any conservative measures will benefit such patients, but if the pain is tolerable and there is no major neurological deficit, then a thorough trial of an individualized exercise activity programme is indicated. If the rehabilitation programme is not effective and pain is intractable, or if there are associated neurological deficits, then surgery should proceed. The operation consists of decompression through adequate foraminotomy. The outcome of surgery should be as good as that enjoyed for acute disc herniation.

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