What is Cervical Stenosis?
Cervical stenosis is a narrowing of the spinal canal that puts pressure on the spinal cord and/or nerves in the neck and upper back. Compression on the nerves can cause pain, numbness, or weakness radiating down the arm. Cervical stenosis causing pressure on the spinal cord can cause more subtle changes over time such as more difficulty of fine motor skills of the hands and difficulty with balance when walking. If the spinal cord is compressed, a step wise progressive neurologic deterioration can occur.
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. These degenerative changes can cause bone spurs and thickened ligaments which can put pressure on the nerves and spinal cord. Another cause of cervical stenosis is a disc herniation, where a piece of the cartilage that provides the cushioning between the vertebrae leaks out and puts pressure on the spinal cord and/or nerve. Other conditions that can cause spinal stenosis include spinal instability, tumors,and traumatic injury.
What are the symptoms?
Many people with cervical stenosis have no symptoms. Patients may also present differently depending if there is compression on the spinal cord versus the nerve.
If a nerve is pinched, it can cause a pain from the back of the neck radiating to back of the shoulder blade and typically down the arm. Sometimes it can present with numbness and tingling. In severe cases it can cause weakness of the arm.
If the spinal cord is compressed, the symptoms often start gradually and worsen over time. Patients often complain of stiffness and pain in the neck shoulders and arms. More typically patients complain of weakness or loss of coordination in their hands. Dexterity and fine motor control worsens, balance and coordination becomes progressively worse. In severe and untreated cases, this can lead to muscle weakness and inability to walk without an assistive device. 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.
This MRI image shows bulging disks pressing on the spinal cord.
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 the symptoms are not controlled with conservative measures, or if the neurologic symptoms are becoming worse, surgery may be necessary. The goal of surgery is to relieve pressure on the spinal cord and nerve roots too allow for improvement of neurologic function and provide pain relief.
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. Usually screws and a titanium plate are used to increase stability.
- Anterior cervical corpectomy and strut graft. This is typically needed if there is pressure on the spinal cord behind the vertebra. The surgeon makes a small incision in the front of the neck and removes the affected vertebrae, as well as the discs and bone spurs to take pressure off the spinal cord. Usually a cage and bone graft is implanted in the space, which works like a strut to support the spine. Screws and a titanium plate are used to hold everything in place while healing occurs and the vertebrae fuse.
- Cervical laminectomy and fusion. The surgeon makes an incision in the back of the neck and removes the bony roof of the spine (the lamina) to open up the spinal canal and create more space for the nerves and the spinal cord. The vertebrae are then fused together to provide stability. Typically rods and screws are used to hold the vertebrae firm as the fusion heals.
- Posterior cervical laminoforaminotomy. The surgeon makes an incision in the back of the neck to reach the spine. The bone or disc fragment compressing the nerve root is removed therefore taking pressure off of the nerve. Depending on the stability of the area a fusion may or may not be needed at the same time.
- 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 to relieve pressure on the nerve. Rather than using a bone graft to fuse, the disc space is fitted with a prosthetic disc. The device preserves motion and eliminates the typical complications of fusion surgery.
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.