Cervical Spinal Stenosis
Cervical spinal stenosis is a condition in which the bones and discs in the neck become arthritic and compress the spinal cord. This pressure on the spinal cord can cause a wide range of symptoms and may even lead to eventual paralysis. Getting an accurate and early diagnosis is critical, and proper treatment can relieve symptoms and prevent irreversible nerve damage.
- Pain or numbness in the shoulders, arms, hands, fingers
- Possible neck pain that is dull or sharp, sometimes accompanied by stiffness and headaches
- Often, there is little or no pain in the neck itself
- Weakness, numbness, or tingling in the arms and hands
- Problems with fine motor function and coordination
- Problems with balance, dexterity, and reflexes
- Other bodily function issues, such as incontinence
- In severe cases, cervical myelopathy which can cause paralysis or severe loss of function
- Symptoms tend to worsen slowly but may go through cycles of remaining stable or rapidly worsening
- Symptoms may flare during certain activities or physical movements
- Arthritis/osteoarthritis of the neck
- Age-related wear and tear on the neck
- Gradual degeneration of bone and cervical discs over time
- Bone spurs on the neck
- Conservative Treatment: Initially, nonsurgical treatments such as lifestyle modifications, physical therapy, medication, and/or spinal steroid injections may be recommended to treat cervical spinal stenosis. However, surgery is usually the only effective treatment for cervical stenosis and will often be the recommended course of action.
- Cervical Stenosis Surgery: This surgery removes the herniated disc and small portions of bone spurs or arthritic bone. It also aligns and decompresses enlarged facet joints. This procedure relieves pressure on the spinal cord to alleviate symptoms.
- Cervical Laminectomy/Posterior Cervical Decompression: This surgery involves removal or restructuring of the lamina and sometimes one or more enlarged facet joints, possibly with fusion of one or more vertebrae.
- Cervical Disc Replacement Surgery: This surgery replaces an arthritic, degenerative cervical disc with a fully mobile artificial disc. This can improve symptoms and allows the neck to continue moving in a natural, physiological way.
- Anterior Cervical Discectomy and Fusion (ACDF): This surgery is performed through a small incision in the front of the neck. The damaged cervical disc is removed, and a bone graft and/or implant is inserted to stabilize and fuse the vertebrae together. This can alleviate symptoms but restricts some movement due to the vertebral fusion.
- Muscle Sparing and Minimally Invasive Fusion: This surgery uses a tubular retractor to allow direct access to the spine with significantly less damage to the soft tissue and muscles. The arthritic disc, bone, and/or bone spurs are removed, and a bone graft and implant are inserted to fuse the vertebrae together. This can alleviate symptoms but restricts some movement due to the vertebral fusion.
- Anterior Cervical Corpectomy and Fusion: This surgery, also performed through the front of the neck, removes a majority of the vertebral body where there is multi-level compression, bone spurs, or disc herniations. It is only performed for individuals with severe spinal cord compression or deformity. This can alleviate symptoms but restricts some movement due to the vertebral fusion.
Frequently Asked Questions
“Stenosis” comes from a Greek word meaning “narrowing” or “choking”. Cervical spinal stenosis is when the bones and/or discs in the neck region of the spine become arthritic and compress the spinal cord. This can occur due to trauma or age-related degeneration. Any formation of bone spurs, swollen ligaments, herniated discs, synovial cysts, or other components that can narrow the spinal canal enough to compress the spinal cord may cause cervical stenosis.
The symptoms of cervical stenosis are often overlooked or misdiagnosed as other conditions, such as carpal tunnel syndrome or peripheral neuropathy. A combination of a detailed medical history, physical examination, MRI, CT scan, X-rays, reflex testing, and other evaluation methods can yield a proper diagnosis.
Surgery is often the only effective treatment for cervical stenosis. As each surgery option has advantages and disadvantages, Dr. Pehler will carefully consider your situation before recommending the best cervical stenosis surgery for you.
The details of your recovery will vary depending on the surgical technique chosen. In most cases, patients can return home on the day of the surgery or within 1 to 2 days. A neck collar may be placed to support the spine as it heals; this may need to be worn for up to several weeks depending on the procedure. Typically, some pain and stiffness are common during recovery but will subside as the tissues heal. More details will be provided for you based on your surgical plan.
All surgeries carry some risks. These include but are not limited to reactions to anesthesia, nerve injury, reduced movement, discomfort, failure to alleviate symptoms, temporary voice hoarseness/change, temporary discomfort when swallowing, and others. The risks of nerve injury are incredibly low due to modern techniques and careful monitoring of the patient during the procedure. All potential risks and benefits will be discussed with you in detail when you are evaluated in clinic.
Cervical spinal stenosis tends to slowly worsen over time. Some individuals go through cycles of remaining stable and then rapidly worsening. A proper diagnosis and treatment can provide healing, stop symptoms from progressing, prevent irreversible nerve damage, and improve your quality of life. Conversely, if cervical spinal stenosis is undiagnosed and untreated, the cells of the spinal cord can die, leading to cervical myelopathy. Individuals with cervical myelopathy may eventually experience paralysis or severe loss of function. If you have any of the symptoms listed above, it is important to see your doctor for an evaluation right away to get an accurate diagnosis and begin your treatment plan.