How can foraminal stenosis be treated?
Patient: 63yr old male patient, vertigo both BPPV and Vestibular, cervical pain w/headaches The signal in the cord and partially imaged posterior fossa is unremarkable. Spinal canal stenosis and kinking of the cord is again noted at the C5 and C6 levels. Disc space narrowing and degenerative endplate signal changes are most apparent at the C5-6 level. No abnormal STIR signal is seen. The vertebral body heights are otherwise well maintained. No evidence of a marrow replacing process to suggest neoplasm or acute trauma is seen. The paraspinal soft tissues are unremarkable. At the C2-3 level, mild narrowing of the right neural foramen is seen. At the C3-4 level, mild narrowing of the neural foramina bilaterally is seen. At the C4-5 level, a left paracentral disc osteophyte complex or protrusion mildly effaces the anterior thecal sac. Narrowing of the neural foramina bilaterally is seen. At the C5-6 level, a mild diffuse disc osteophyte complex with protrusion of the inferior C5 and superior C6 end plates posteriorly is seen. Mild compression of the cord at this level is seen. No cord edema is seen. Narrowing of the neural foramina bilaterally is seen. At the C6-7 level, mild to moderate diffuse disc osteophyte complex effaces the anterior thecal sac and mildly narrows the neural foramina bilaterally. At the C7, T1 level, no significant disc osteophyte pathology is demonstrated. At the T1, T2 level, no significant disc osteophyte pathology is demonstrated. The partially imaged parotid and submandibular glands are unremarkable. The parapharyngeal spaces are fairly symmetric. The thyroid gland is not well visualized. No definite enlarged lymph nodes are seen. Facet hypertrophy is noted at multiple levels. Impression: Degenerative endplate signal changes with spinal canal stenosis at the C5-6 level. Associated mild disc osteophyte complex. See above discussion of each vertebral level. No cord edema. Suggestive possible treatments. Doctor: Hello,  The main treatment for chronic degenerative cervical changes such as in your case is with physical therapy and painkillers.   Pain killers consist first in over the counter anti-inflammatory medication such as Ibuprofen and if not enough medication for chronic pain such as Gabapentin or Duloxetin.   Mind you that medication is only to alleviate symptoms, it is an only physical therapy which has a benefit in the long term.  If symptoms persist in local shots of steroids and analgesics may be tried.  If there are symptoms indicating cord compression and neurological deficits on physical examination then surgery might be considered.  Hope I have answered your query. Let me know if I can assist you further.  Take care  Regards, Dr Olsi Taka, Neurologist