Cervical spinal stenosis
What is cervical spinal stenosis?
Most cervical problems are due to degenerative changes that occur in the discs and joints of the neck. Degenerative changes that affect the structures of the spine can cause the spinal canal to become too narrow, a condition called spinal stenosis. This may lead to pressure on the spinal cord. Bone spurs that stick into the spinal canal take up space, making the spinal canal smaller. They can press against the spinal cord or nerve roots, which can cause pain and discomfort.
What causes cervical spinal stenosis?
Cervical spinal stenosis is usually caused by age-related changes in the shape and size of the spinal canal, and it’s most common in people over 50 years of age. The aging process can cause bulging discs, lead to the destruction of tissues that cover bones, and excessive growth of the bones in joints. All of these conditions can narrow the spinal canal, causing spinal stenosis.
Finding the cause of your neck problem begins with a complete history and physical exam. To make sure of the exact cause of your neck pain, several diagnostic tests can be used. Standard X-rays, taken in the doctor’s office, are usually a first step in looking into any neck problem and will give your doctor an idea of whether cervical spinal stenosis exists. Your doctor will also determine whether other tests, such as an MRI, are needed.
The symptoms from spinal stenosis depend on whether pressure is affecting the spinal nerve roots or the spinal cord. A “pinched” nerve in the neck (radiculopathy) usually only causes symptoms in the neck and arms. Pressure on the spinal cord (myelopathy) can affect the arms and legs.
Radiculopathy is a condition that can happen from pressure on a spinal nerve root. Commonly thought of as a "pinched nerve," this type of pressure feels different than pressure on the spinal cord. Pressure on an irritated or inflamed nerve root may produce feelings of pins and needles in the area supplied by the nerve root. The pain may feel deep, dull, and achy. Or you may have sharp, shooting pain along the path of the nerve. Muscles controlled by the affected nerve root may also weaken. Muscles controlled by the affected nerve root may also weaken.
Pressure on the spinal cord (myelopathy) is a greater concern, because it can lead to permanent spinal cord damage. Symptoms from myelopathy vary. Feelings of numbness or weakness can affect both arms and both legs. A loss of muscle control in the legs, called spasticity, may cause difficulty walking. "Position sense" may be lost in the arms or legs. This affects the ability to know where your arms or legs are when your eyes are closed. When this occurs it becomes difficult to use the arm and hands and to know where you are placing your feet as you walk. Myelopathy may disturb the normal function of the bowels and bladder.
Doctors take these symptoms very seriously because severe myelopathy that is not treated may lead to permanent nerve or spinal cord damage. Pressure on nearby nerve roots can cause radiculopathy and may produce pain, weakness, or sensory changes in the area supplied by nerves that go from the cervical spine to the shoulder, arm, or hand.
If your condition is causing only mild symptoms and does not appear to be getting worse, your doctor may have you work with a physical therapist. A well-rounded rehabilitation program assists in calming pain and inflammation, improving your mobility and strength, and helping you do your daily activities with greater ease and ability.
Epidural Steroid Injection (Nerve Block)
If other treatments do not relieve your neck pain, you may be given an epidural steroid injection, also called a nerve block. An ESI places a small amount of cortisone into the bony spinal canal. Cortisone is a strong anti-inflammatory medicine that may control the inflammation surrounding the nerves and may ease the pain caused by irritated nerve roots. This injection is often used when other conservative measures do not work, or in an effort to postpone surgery. This treatment is not always successful, but may provide short-term help.
There are several surgical procedures used to treat cervical spinal stenosis that is causing cervical myelopathy; all have the same goal: to relieve the pressure on the spinal cord by making the spinal canal larger.
Your surgeon may suggest an operation called a laminectomy, in which the backside of the vertebrae is opened to allow more room for the spinal cord. Discectomy, the removal of one or more discs, may be suggested if stenosis is coming from problems of disc herniation. This surgery may be done from the front or back of the spine. Or your surgeon may suggest an operation that is done from the front of the neck-a corpectomy and strut graft. This operation involves removing the discs and vertebral bodies in the area where problems are occurring. Bone spurs that are pushing into the spinal cord are also removed. The vertebrae are then replaced with a solid piece of bone graft (called a strut graft). The strut graft heals over time to create a solid fusion of the spine where the vertebral bodies have been removed.
Procedures / Surgeries
Cervical myelopathy can be a serious problem. The pressure on the spinal cord usually will not go away without surgery, and the symptoms may continue to get worse. If you do not improve with nonoperative care, your doctor may suggest surgery.