Cervical Stenosis

Symptoms

Neck pain; pain that extends toward the shoulder, between the shoulder blades, and even pain in the back of the head. There may also be radicular symptoms with pain, numbness, or weakness extending into the arms or legs. If severe, loss of coordination and bowel or bladder incontinence may occur.

About this Condition

The narrowing of the spinal canal, called spinal stenosis, can happen as a result of the degeneration and subsequent enlargement of the facet joints, spinal ligaments, bony end plates, and the intervertebral discs. In this condition, bone spurs, called osteophytes, which develop because of the excessive load on the intervertebral disc, grow into the spinal canal.

The facet joints also enlarge as they become arthritic, which contributes to a decrease in the space available for the nerve roots. The ligaments of the spinal column, especially the ligamentum flavum, become stiff, less flexible and thicker with age, which also contributes to spinal stenosis. These processes narrow the spinal canal and may begin to impinge and put pressure on the nerve roots and spinal cord, creating the symptoms of spinal stenosis.

Stenosis may occur in the central spinal canal (central stenosis) where the spinal cord or cauda equina are located, in the lateral part of the spinal cord (lateral recess stenosis) or in the lateral foramen (foraminal stenosis) where the individual nerve roots exit out to the body.

Some distortion of the spinal canal will occur in virtually every person as they age, but the severity of the symptoms will depend on the size of a person's spinal canal and the encroachment on the neural elements. The rate of deterioration varies greatly from person to person, and not everyone will feel symptoms.

Spinal stenosis may be caused by a number of processes that decrease the amount of space in the spinal canal available for the neural elements. Degenerative causes are the most common, but there are a few unusual causes of stenosis. These include calcium pyrophosphate crystal deposition, amyloid deposition, and intradural spinal tumors.

[Source: Medtronic]

This content is for your general education only. See your doctor for a professional diagnosis and to discuss an appropriate treatment plan.

Conservative Treatments

Medication and Pain Management

The goal when prescribing medications should be maximum reduction of pain and discomfort with minimal risk of overuse of the medications and avoiding side effects.

Non-steroidal anti-inflammatory medications (NSAIDs) include common over-the-counter drugs such as aspirin, ibuprofen and naproxen among others. These drugs are potent long-term pain reducers that work without concerns of dependence.

Opioid therapy to control chronic back pain is less ideal because of potential toxicity to the body and physical and psychological dependence. Treatment by this class of drugs should generally be a short term option when patients do not respond to alternatives.

Pain can often be reduced through the use of muscle relaxants, anti-seizure pain medications such as Neurontin, Topamax, and Lyrica, anti-depressants, and oral steroids.

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Physical Therapy / Occupational Therapy

Physical and occupational therapy can play a vital role in your recovery. Once acute pain improves, your doctor or a therapist can design a rehabilitation program to help prevent recurrent injuries.

These programs often include heat, cold and electrotherapy to help alleviate pain, decrease swelling, increase strength and promote healing. Methods include therapeutic exercise, manual therapy, functional training and use of assistive devices and adaptive equipment to increase strength, range of motion, endurance, wound healing and functional independence.

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Surgery

Anterior Cervical Discectomy with Fusion

Anterior cervical discectomy with fusion is an operation that involves relieving the pressure placed on nerve roots, the spinal cord or both by a herniated disc or bone spurs.

Through a small incision made in a natural deep skin crease in the front of the neck, the surgeon:

Removes the intervertebral disc to access the compressed neural structures
Places a bone graft to fuse adjacent vertebrae
In some cases, implants a small metal plate to stabilize the spine while it heals
In certain cases, an artificial disc may be placed

Cervical Laminectomy

A cervical laminectomy is a spine surgery that involves removing some posterior bone to relieve excess pressure on the nerves in the cervical spine, or neck. A cervical laminectomy can be performed to relieve the symptoms of spinal stenosis, the narrowing of the spinal canal.

The term laminectomy is derived from the Latin words lamina (thin plate, sheet or layer), and -ectomy (removal). A laminectomy removes or “trims” the lamina (roof) of the vertebrae to create space for the spinal cord and nerves leaving the spine.

Spinal stenosis is a condition caused by a gradual narrowing of the spinal canal. This narrowing happens as a result of the degeneration and subsequent enlargement of the facet joints, spinal ligaments, bony end plates, and the intervertebral discs. The facet joints also enlarge as they become arthritic, which contributes to a decrease in the space available for the nerve roots. Bone spurs, called osteophytes also can form and grow into the spinal canal.

[Source: Medtronic]

Please keep in mind that all treatments and outcomes are specific to the individual patient. Results may vary. Complications, such as infection, blood loss, and bowel or bladder problems are some of the potential adverse risks of surgery. Please consult your physician for a complete list of indications, warnings, precautions, adverse events, clinical results and other important medical information.

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