Cervical stenosis develops when either the spinal canal or nerve passageways (foramen) become narrow. It is a common cause of neck pain. If the spinal canal is narrowed, the disorder is also termed cervical central stenosis. If the foramen is narrowed, it is called cervical foraminal stenosis. When either condition develops, the spinal cord and/or nerves are compressed. Sometimes, patients have both types of cervical stenosis.
Some patients are born with this narrowing (congenital cervical stenosis). However, most cases of cervical stenosis develop in patients over age 50 and result from aging and wear and tear on the spine.
Many patients with cervical stenosis have a history of neck injury or trauma. Trauma may have occurred months or years before the onset of stenosis symptoms.
Symptoms
The symptoms of cervical spinal stenosis may include:
- Neck pain; not always severe
- Pain, weakness, or numbness in the shoulders, arms, and legs
- Hand clumsiness
- Gait and balance disturbances
- Burning sensations, tingling, and pins and needles in the involved extremity, such as the arm or leg
- In severe cases, bladder and bowel problems
- Although rare, severe cases can cause loss of function or paraplegia
Diagnosis
An accurate diagnosis of cervical stenosis can be made by an expert physician specializing in spinal disorders. The steps involved in the diagnosis may include:
- Medical history. Your doctor inquires about symptoms, their severity, what treatments you have already tried and the results.
- Physical examination. The physician will examine you for limitations of movement, balance problems, and pain. The physician will test your reflexes at the extremities and evaluate muscle weakness, loss of sensation, and signs of neurological injury.
- Diagnostic tests. X-rays may help rule out other problems, such as a tumor or infection. CT scans and MRIs may be performed to obtain more detail, such as evidence of a herniated disc or osteophytes (bony growths). Sometimes, myelography is performed. Myelography involves injecting contrast dye into the spinal column to visually enhance areas where the spinal cord or nerve roots may be pinched.
Nonoperative Treatment
Many different nonsurgical treatments may help relieve symptoms. These include:
- Medications, such as an anti-inflammatory drugs to reduce swelling and pain, muscle relaxants to calm spasm, and occasionally, painkillers (non-narcotic or narcotic) to alleviate pain.
- Cold/heat therapy, especially during the first 24 to 48 hours of pain onset.
- Spinal injections (i.e. epidural) may help relieve neck and related upper extremity pain.
- Physical therapy, which may include gentle massage, stretching, therapeutic exercise, bracing, or traction to decrease pain and increase function.
- Alternative therapy (i.e. acupuncture).
During physical therapy, patients will be instructed in proper posture and body mechanics to help enhance healing and prevent further injury.
Surgical Treatment
If nonsurgical measures are not successful, surgery may be recommended. There are several different surgical techniques to treat cervical stenosis. The goal of surgery is to decompress, or take pressure off the spinal cord and nerve roots. Decompression involves removing or trimming whatever is causing compression. The surgeon will discuss the most appropriate procedure for a particular patient along with its associated risks and benefits.
- Decompressive laminectomy is a common surgical procedure to treat cervical stenosis. This procedure removes the lamina (vertebral roof) to create more space in the spinal canal for nerves. If only part of the lamina is removed, the procedure is a decompressive laminotomy.
- A posterior laminoplasty expands the size of the spinal canal by lifting the lamina on one side. This procedure retains spinal stability and reduces the need for fusion.
- A discectomy removes part of, or an entire disc, such as a herniated disc that compresses nerve structures.
- A foraminotomy enlarges the size of the foramen to decompress nerve roots.
- Instrumentation and fusion are performed to stabilize the spine and may be combined with another procedure, such as discectomy. Instrumentation (i.e. screws, plates) and fusion (bone graft) joins and stabilizes two or more vertebrae.
This list is not exhaustive. An expert surgeon may recommend other procedures for a particular patient.
Surgical Recovery
Most patients begin to get out of bed the same day surgery is performed. Activity is gradually increased and patients are discharged home within a few days after their procedure, depending on the type and extent of the surgery. As with most surgeries, expect some pain after the procedure. Your doctor will provide pain medication to help keep you comfortable.
At home, you need to continue to rest. You are given instructions how to safely and gradually increase activity. Pain medications may be needed for a while. However, pain and discomfort should begin to reduce within a week or two after surgery. Information about other ways to reduce pain and increase flexibility is provided, along with instructions about when normal activities may be resumed and when the patient may return to work, if appropriate.
Conclusion
Cervical stenosis is a painful and potentially serious condition that may be safely and effectively treated when accurately diagnosed. Consult with a physician with exerptise in spinal conditions if you have the above-described symptoms or think you may have cervical stenosis.