Foraminal herniations are a less frequent type of disc herniation. The name refers to the location where they occur, in the exit hole of the nerve. The experts at Instituto Clavel explain their main causes, the most common symptoms and the available treatments.
There are different types of disc herniations and, although today’s article focusses on foraminal herniations, we’d first like to provide some information about the existing classification of hernias with regard to their location in the spinal canal and the hole through which the nerves exit.
The most common are paracentral hernias, which are those that are located at the entrance to the neural foramen. These can compress the nerve roots that come out of the hole at either that level or the lower one. Next on the list are central hernias, which are located in the center of the spinal canal, under the dural sac. These do not usually cause any symptoms if they are not large.
After these, come the foraminal hernias, which, as we said, are inside the hole through which the nerve roots exit. Unlike the preceding two types, they can cause symptoms even when they are not very large. Finally, the least frequent are extraforaminal hernias, which are outside the foramen.
Causes of foraminal herniations
This type of hernia is caused by the same thing as other disc herniations. The most common cause is degeneration or natural wear and tear on the intervertebral discs that act as a cushion for the vertebrae. Over the years, they become less flexible and can rupture, producing a hernia.
Disc herniations can also be the result of other causes, such as genetic factors, jobs requiring repetitive movements that place stress on the spine, a history of poor posture, excess body weight, smoking, and, although less frequently, an accident or injury.
With respect to these causes, except for cases where there is some genetic factor, maintaining a balanced diet, regular exercise, and making a habit of using good posture, can help prevent disc degeneration and the development of herniations.
Symptoms of foraminal herniation
As we said earlier, a foraminal disc herniation can cause symptoms even when it is not very large. Below are the most common symptoms:
- Pain in the upper or lower back.
- Pain radiating to the shoulder or arm if the hernia is in the cervical spine, or to the buttock or leg if it is in the lumbar spine.
- Weakness in the muscles that depend on the nerve root compressed by the herniated disc.
- Tingling or numbness in the area of skin affected by the damaged nerve root.
More serious symptoms such as loss of mobility or difficulty standing, among others, can also appear.
We recommend that you consult a specialist in the spine if you have these symptoms and back pain or radiating pain does not subside in 3 days despite taking pain relievers and resting.
Treatment for foraminal disc herniation
There are various treatment options for foraminal disc herniations. At Instituto Clavel, whenever possible, we prefer to use conservative treatments that improve the patient's quality of life without the need for surgical intervention. Here are some of the conservative alternatives:
- Medication for pain in the upper or lower back.
- Manual physiotherapy and specialized active therapy for the spine. At IC Rehabilitation, they design a personalized plan according to the needs of the patient, which can include exercises to strengthen the spine.
- Localized infiltrations to relieve pain.
If these treatments do not work or if the patient's situation is already very serious when they first come to our office, it may be necessary to perform surgery to remove the hernia and relieve the nerve root compression.
Given the location of the foraminal hernia, we can access it using a lateral approach to the spine, which allows us to pass between the muscles without having to manipulate or cut them. With this technique, we avoid eliminating the facet, which would involve fixation of the disc with screws and a consequent loss of mobility in that disc. In addition, by respecting the muscles and going straight to the hernia, we do not injure any structures and recovery is faster.
In this video, Dr. Pablo Clavel explains this surgery in detail.