Cervical spinal stenosis is a narrowing of the spinal canal in the neck.
Spinal stenosis is a narrowing of the spinal canal, which places pressure on the spinal cord. When found in the neck, it is called cervical spinal stenosis.
This is not to be confused with the more common spinal condition, lumbar spinal stenosis, which affects the lower back and–while still serious–tends to be less dangerous than its cervical counterpart.
Given the potential severity of spinal stenosis of the neck and the number of procedures that can be used to address it, patients considering treatment should fully understand their options and seek out an informed second opinion to ensure they pursue the right option for their specific needs.
Following is information to help you understand the condition and your options.
Symptoms of Cervical Spinal Stenosis
- General weakness in the body
- Loss of balance
- Loss of dexterity in the fingers
- Loss of bowel or bladder function, in progressed cases
Myelopathy is the term used to describe the constellation of neurological symptoms that develop as the result of chronic and progressive spinal cord compression.
Myelopathy is most often caused by a combination of disc bulging, osteophyte (“bone spur”) formation and overgrowth of the joints of the spine. We call this a disc-osteophyte complex that in conjunction with overgrowth of the spinal ligaments (ligamentum flavum) can cause narrowing of the diameter of the spinal canal (stenosis). This mechanical compression can be static or dynamic (worse with motion like neck extension). It can also develop as a result of progressive degenerative changes of the spine which cause a decrease in disc space height and can be associated with a loss of the normal curvature of the spine (lordosis) and osteocartilaginous overgrowth.
In many patients compression of the spinal cord can be asymptomatic, even in the presence of advanced changes seen on an MRI.
Since stenosis develops slowly, the body is typically able to accommodate and tolerate these changes. It is the mechanical compression of the spinal cord that results in myelopathy. Once central stenosis has occurred, even minor injuries have the potential to cause an insult to the spinal cord, which can result in an acute and significant neurologic deficit.
Symptoms: A Closer Look
Myelopathy may manifest itself as a loss of dexterity in the fingers, loss of balance, or unsteadiness with walking.
Specific examples include having difficulty with buttons, using small tools or putting on jewelry, a change in handwriting, dropping objects, or heaviness or weakness in the arms or legs. When stenosis is severe, the symptoms can progress to include a loss of bowel or bladder function. The physical exam for myelopathy includes testing for hyperactive or abnormal reflexes and muscle weakness.
Surgery for Cervical Spinal Stenosis
Cervical myelopathy is a serious problem. The pressure on the spinal cord typically won’t go away without surgery and the symptoms will most likely continue to get worse.
If you do not improve rapidly with non-operative care, surgery will be recommended to relieve the pressure on the spinal cord. Sometimes surgery is performed simply to prevent the progression of symptoms.
With Many Options to Consider, a Second Opinion Helps You Chose
Since there are several surgical procedures to consider when evaluating treatment for spinal stenosis of the neck, a second opinion can be of great help. Naturally, you want to ensure you are selecting the right procedure for your specific case.
While the goal of the operation is to relieve the pressure on the spinal cord by making the spinal canal larger, the processes by which that is accomplished can vary greatly. In particular, the type of surgery recommended depends on the location and extent of the cervical pathology.
Myelopathy can be treated by an anterior (from the front) or posterior (from the back) approach. The choice of the approach depends on factors including the site and degree of cord compression and the number of spinal levels involved. This decision can result in potentially different outcomes and recoveries, so it is essential to evaluate thoroughly before proceeding.
An anterior decompression may be accomplished by removing the vertebral body (corpectomy) and replacing it with a solid piece of bone graft. Posterior decompression takes the form of a laminectomy in which we remove bone from the back of the spinal column in order to make more room for the spinal cord. With either procedure, a spinal fusion may be necessary to maintain or restore stability in that portion the spine.
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