Cervical Spinal Stenosis
What is cervical spinal stenosis?
Cervical stenosis is a narrowing of the spine that puts pressure on the spinal canal and nerves in the neck. This squeezing can change how the spinal cord functions and cause stiffness, pain and numbness in the neck, arms and legs. In severe cases, cervical stenosis can cause major body weakness or even paralysis if the spinal cord is damaged.
How does cervical stenosis occur?
While some people are born with a small spinal canal, the most common cause of cervical stenosis is degenerative changes in the spine related to aging. Other causes include spinal instability, disc herniation, osteoporosis, tumors, accident, traumatic injury and constriction of blood supply to the spinal cord.
What are the symptoms?
Many people with cervical stenosis have no symptoms. When symptoms do occur, they often start gradually and worsen over time. Common symptoms include:
- Stiffness, pain or numbness in the neck, shoulders, arms, hands or legs
- Balance and coordination problems
- Muscle weakness
- Incontinence (loss of bladder or bowel control)
Severe cases of cervical stenosis can cause paralysis if the spinal cord becomes too compressed.
How is cervical stenosis diagnosed?
In addition to a complete physical exam and patient history, your doctor can use specific tests, including X-ray, MRI and CT scan, to diagnose cervical stenosis.
What is the treatment?
In patients with mild cervical stenosis, non-surgical treatment is often effective. This includes activity modification, non-steroidal anti-inflammatory medication, corticosteroids, epidural injections or physical therapy. If these conservative measures don’t work, surgery may be necessary. The goal of surgery is to relieve pressure on the spinal cord and nerve roots.
There are several appropriate and successful surgical options, including:
- Anterior cervical discectomy and fusion. The surgeon makes a small incision in the front of the neck to reach the spine. The affected disc between the vertebrae is removed and the vertebrae are fused together with a bone graft. Sometimes screws or a titanium plate are used to increase stability.
- Cervical laminectomy and fusion. In this two-part procedure, the surgeon removes the bony roof of the spine (the lamina) to open up the spinal canal and create more space for the nerves The vertebrae are then fused together to provide stability. In some cases, rods or screws are used to hold the vertebrae firm as the fusion heals.
- Corpectomy and strut graft. The surgeon makes a small incision in the front of the neck and removes the affected vertebrae and discs to take pressure off the spinal cord. Bone spurs are removed as well. A bone graft is implanted in the space, which works like a strutto support the spine. Screws and a titanium plate are used to hold everything in place while healing occurs and the vertebrae fuse.
- Cervical disc replacement. This procedure is an exciting advancement in spine surgery and, for carefully selected patients, a good alternative to the traditional fusion technique. The surgeon removes the diseased disc and, rather than using a bone graft to fuse, replaces it with a prosthetic disc. The device preserves motion and eliminates the typical complications of fusion surgery. Because this technique avoids spinal fusion, it may result in a faster recovery. However, as with all surgical procedures, specific recovery time varies by patient and demand.
The type of procedure performed depends on the severity of the cervical stenosis, as well as a patient’s overall health and other factors. Not everyone is a candidate for disc replacement surgery. A surgeon who is trained in both spine fusion techniques and disc replacement technology is the best person to determine the most appropriate surgical option for the patient. A consultation with the proper surgeon is crucial in making that determination.