Foraminal Stenosis


What is foraminal stenosis?

Foraminal stenosis is a narrowing of the intervertebral foramen which are narrow openings along your spine. In a way, they are like conduits that protect the wiring of your nervous system as it winds through the skeletal system of the spine. These delicate nerves or ganglion run from your spinal cord to your extremities. Each of the 23 intervertebral discs of your cervical, thoracic and lumbar spine are positioned adjacent to the openings of the foramen. Therefore, if one of your discs slips or herniates, the foramen openings could be narrowed which will compress nerves and activate pain. Nature has designed the spine to be rugged, and compact so there is not a lot of leeway in the design of these openings.

What causes foraminal stenosis?
The nerves running through the foramen connect to your extremities. The pain that is generated is similar to the pain of a herniated disc which means it radiates from your extremities and is called radiculopathy. If you have tingling pain along your buttocks, hips, legs, and feet the location of the stenosis is in your lower spine (lumbar). You may also experience weakness in your legs and numbness. If the pain that you are experiencing is in your shoulders, arms or hands, the location is in your upper spine (cervical).

Your treating physician may require additional information to pinpoint the source of the stenosis and may suggest using X-rays, MRIs, CT scans or electrophysiological tests. Information is key when it comes to identifying the biomechanical causes of your back pain.

How is foraminal stenosis treated?
The best way to characterize foraminal stenosis is as a pinched nerve. The objective of the conservative, non-surgical treatment plan is to naturally decompress the nerve over time.

If your doctor has identified your condition as lumbar foraminal stenosis, he or she may suggest that you work with a physical therapist and focus on lumbar extension and flexion exercises to stretch your nerves in much the same way as you would stretch a muscle to tone it.

If your problem is cervical foraminal stenosis, the conservative non-surgical treatment program may include over the counter anti-inflammation medicines, physical therapy and at-home traction units. For some cases, your doctor may suggest central and transforaminal epidural steroid injections which will help reduce inflammation and pain. Some physicians may prescribe opioid-based pain relievers.

Dr. Nourian is a great believer in integrative medicine techniques which may include yoga, acupuncture and chiropractic treatments. His conservative treatment plans are opioid-free and use diet and lifestyle assessments to help patients relieve back pain naturally. Most patients experience pain relief after two to three months of treatment without surgery or opioids.

A small percentage of patients may not respond to the conservative approach and may require surgery. Perhaps the optimal treatment is foraminal decompression using microsurgery techniques to reduce damage to soft tissue, muscles and bone structures. Some cases with spinal instability may require more intensive surgical solutions such as artificial disc replacement or disc fusions both of which are more invasive(1).

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What Patients Think About Dr. Nourian

Awesome awesome doctor!!!very nice to all his patient! Dr. Nourian is very kind and caring. A very pleasant man and easy to communicate with. He saw my son when he injured his hip and He took extra good care of him. After 2 wks he was able to resume sports. He’s not only a very good orthopedic surgeon but also an amazing Spine doctor. He always make sure he always gets the job done. 2 Thumbs up to this Doctor!!!??

Regz Ramos


Dr. Nourian was fantastic! He was able to alleviate my back pain. I would recommend him to anyone

Nikesh Patel


Dr. Nourian is the best. His bedside manner is friendly and professional and his staff is excellent. I went to see him after a terrible whiplash injury when I rear-ended while driving. After receiving my MRI results, the doctor was quick to reach out and went over my options with me. He really cares about his patients.

Michelle Sadighpour Shophet


Dr. Nourian is an outstanding physician. I injured my back while exercising recently. I went to see him, and he explained my injury to me in detail. He told me that my injury would most likely heal without surgery, but if I needed surgery in the future he would get me through it. He is honest, intelligent, and forthcoming. I am thankful for him as my spine physician.

Michael Broukhim


Dr. Nourian was absolutely fantastic. I was struggling with intense lower back pain. He took his time 40 minutes to be exact to see me and review everything with me after another follow up we decided to do surgery. Thank god!!! I’m back to working out, picking up my child, and living my best life. I was so hesitant to do surgery but he was a true god send. He would call me weekly to see how I’m doing.

Sara Sadig


Dr. Nourian is smart, caring, attentive and super knowledgeable. I highly recommend him as an orthopedic surgeon!

Sharon Darouvar Greiner


Great with patients and consciences of patient’s time as well as needs. He will spend time to assure the patients with respect to treatment plan and follow-up was amazing with my auntie’s back issues.

Connie Esparza


An extremely knowledgeable doctor with wonderful bedside manner. He clearly explained every step of the procedure and eased all my worries. My back is feeling great thanks to Doctor Nourian

Ashley Sadig


After seeing three doctors and all of them saying I should operate Dr Nourian was able to address and issue without and surgery. I got an epidural and did physical therapy and I’m able to run around with my grand child. He’s truly a gem. Everyone at the office was friendly and supportive.

Katrin Sadighpour


Dr. Nurian explained everything very well and preformed the surgery exactly as planned. I woke up pain free and the surgery pain was gone in five days. Could not give him enough praise.

Wade Savage