Cervical foraminal stenosis

Last revised by Dr Henry Knipe on 29 Jun 2022

Cervical foraminal stenosis is a common condition that is mostly asymptomatic but in some results in cervical radiculopathy.

Cervical foraminal stenosis is most commonly asymptomatic but can result in cervical nerve root compression, which in turn results in cervical radiculopathy (brachalgia) 1

Cervical neural exit foraminal stenosis is most commonly from uncovertebral arthrosis or facet joint arthropathy with degenerated disc disease less common 4

There are a number of proposed grading systems for cervical foraminal stenosis with excellent inter-reader correlation 1. Using the Park system, grades 2 and 3 are associated with positive neurologic manifestations with low sensitivity (~40%) and high specificity (~99%) 5,6

This grading is performed on axial T2WI at the level of the disc 2:

  • grade 0 (normal): narrowest width of the neural foramen is more than the extraforaminal nerve root width at the level of the anterior margin of the superior articular process
  • grade 1 (moderate or non-severe stenosis): narrowest width of the neural foramen is 51–100% of the width of the extraforaminal nerve root at the level of the anterior margin of the superior articular process
  • grade 2 (severe stenosis): narrowest width of neural foramen ≤50% of
    extraforaminal nerve root width

This grading is performed on sagittal oblique T2WI 3:

  • grade 0: absent stenosis
  • grade 1 (mild stenosis): partial (<50% of root circumference) perineural fat obliteration surrounding the nerve root without nerve root morphological change
  • grade 2 (moderate stenosis): near-complete (>50% of root circumference) perineural fat obliteration without nerve root morphological changes
  • grade 3 (severe stenosis): nerve root morphological change, e.g. collapse, combined with perineural fat obliteration

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