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Stenosis of the Intervertebral Foramen
Definition: A reduction in the space provided by the foramen transversarium.
Causes: There are numerous factors, which can result in stenosis of the foramen transversarium. Causes of foraminal stenosis include: disc herniations, osteophyte formation.
Examination: The presentation can vary in accordance with the extent of neurological damage associated with the intervertebral foramen stenosis. Signs of a lower motor neurone disease may be present along the nerve root(s) affected by the foraminal stenosis: hyporeflexia, hypotonia, fasciculations, and asthenia along with some sort of radiculopathy.
Orthopaedic examination of intervertebral stenosis:
Neural tensioning: the test is done to determine the status of a specific nerve root or roots. Examples include: slump test, straight leg raise test, median, ulnar, and radial neuritis tests, etc. The principle behind these techniques, is to tease the nerve root(s) at the spinal cord, using the limbs as levers, and passively introducing a series of sensitising factors. A positive is indicated by an aggravation in symptoms.
Tinnels test: this is most applicable for a foraminal stenosis at the cervical spine where the practitioner can passively side-bent the patient's head away from the symptomatic side and percuss over the affected nerve root. A positive is indicated by an aggravation in symptoms.
Valsalva maneuveur: This test is most sensitive to foraminal stenoses of a discal origin. The patient is instructed to forcibly exhale against their closed airways. An aggravation in symptoms indicates a positive. Definitive diagnosis of a intervertebral foramen stenosis can be achieved via MRI.