Cervical Spinal Stenosis
The normal cervical spine is composed of seven building blocks called
vertebrae that sit on the thoracic (chest) spine. At the upper end of
the cervical spine sits the head. The cervical spine allows you to bend
your head forward (flex) and backward (extend) and tilt and twist your
head to the left and right. Each vertebra is constructed of a body, lamina,
and pedicles, which surround an opening, the spinal canal.
|
Cervical spinal stenosis is a progressive narrowing of the spinal
canal. Between each pair of vertebra is a fibrous intervertebral
disk. Collectively, the vertebrae and disks are called the backbone.
The spinal cord and the nerves leaving and entering it run through
the spinal canal. Stenosis simply means a narrowing in the spinal
canal, much like a kink in a garden hose. When the spinal canal
narrows, the nerves and the spinal cord are squeezed. When the nerves
are compressed by inadequate space, the patient experiences pain
and weakness in the arm on the effected side. When the spinal cord
is compressed the patient can have trouble as subtle as an unsteady
walking, to complete paralysis and numbness from the neck down.
Spinal stenosis usually affects people over 50 years of age. Women
have the condition more frequently than men do.
|
|
Cervical Stenosis Demo
Click here
if you don't have the plugin for your browser. |
|
The development of stenosis is usually gradual, but once started, the
symptoms can develop rapidly. Once the spinal cord is damaged in this
way, recovering may not be possible. At this stage, surgery may only halt
the progression of the damage.
Cervical Stenosis with Spinal Cord Compression
MRI showing spinal cord compression
As we age, the spine may develop degenerative changes in the joints
that can create narrowing of the spinal canal. Over time this process
may lead to compression of the spinal cord. Compression of the spinal
cord is referred to as myelopathy.
People with spinal cord compression from stenosis may note one or more
of the following symptoms:
- Heavy feeling in the legs
- Inability to walk at a brisk pace
- Stumbling
- Deterioration in fine motor skills (such as handwriting or buttoning
a shirt)
- Intermittent shooting pains into the arms and legs (like an electrical
shock), or this sensation may shoot down the spine when bending their
head forward (known as Lermitte’s phenomenon)
- Arm pain (radiculopathy)
Often it is the arm pain that prompts someone to seek medical treatment,
and then the myelopathy (the spinal cord injury) is discovered through
medical history and physical exam.
Diagnostic tests
An MRI scan and/or a CT with myelogram can show the tight spinal canal
and associated spinal cord pinching. The condition may be present at one
or several levels in the spine.
Often, cervical stenosis with myelopathy is associated with some degree
of instability, and flexion/extension lateral cervical spine x-rays are
useful to rule out abnormal motion and instability.
Treatment
The only effective treatment for myelopathy is surgical decompression
of the spinal cord. The injury to the spinal cord is generally progressive
condition and can be very devastating. Symptoms may not progress for years,
and then difficulties with walking may suddenly increase. Unfortunately,
the symptoms rarely improve without surgery to decompress the affected
area.
And in many situations the injury to the spinal cord is irreversible.
Typically, the main goal of surgery is to arrest the progressive nature
of the condition and stabilize the patient’s neurological condition.
Surgical decompression can be performed through an anterior (front) approach
or posterior (back) approach. The type of approach is generally dependent
on the surgeon’s preference and where the majority of the compression
is located (in the front or back). Often, multiple levels need to be decompressed,
so the surgery tends to be more involved than that for disc herniations
or foraminal stenosis.
For details of this surgery link to the page "Cervical
Laminectomy."
Cervical foraminal stenosis (without myelopathy)
Foraminal stenosis (narrowing of the exit for the nerves) may arise without
any disc herniation, but rather by the spurring and bone over growth directly
over a nerve. The majority of symptoms are usually caused by one nerve
root on one side. Typically, the condition is characterized by:
- The pain develops slowly (versus acute pain)
- May develop over many years
- The pain is not continuous
- The pain is related to an activity (such as bicycle riding) or position
(such as holding the neck in an extended position)
- The condition is caused by enlargement of a facet joint (joints between
the vertebrae) in the spinal canal and can be confirmed by either an
MRI scan or a CT with myelogram.
Unlike many other back or neck conditions, most conservative treatments
(such as medications or other modalities) are unlikely to be of much benefit.
Traction may provide some pain relief.
Most often, patients choose either activity modification or surgery to
relieve pressure in the nerve root.
Activity modification
If patients are not unduly troubled by foregoing a few activities
and are not in a great deal of discomfort, choosing to live with the condition
is a reasonable option. Delaying or avoiding surgery is not dangerous,
and surgery may always be considered at a later date.
Surgery
Surgery either includes an anterior cervical discectomy and fusion
(See Cervical Disc Surgery Page) in which the disc is removed and the
disc space is distracted open to allow opening of the foramen and give
the nerve root more room. A bone graft is left in the disc space to keep
in distracted. The surgical procedure is reliable in terms of pain relief
and has minimal morbidity (such as postoperative pain). It can usually
be done with an overnight hospital stay and then takes about 2 to 6 weeks
to return to normal activities. Or, your surgeon may choose a posterior
foraminotomy, whereby a posterior approach may allow removal of the spur
to decompress the nerve and not require fusion.
Links
CT
Scan
MRI
Scan
Myelogram
Cervical
Spine @..
About Surgery
Cervical (Neck)
