Cervical Stenosis Surgery
Surgery for cervical spinal stenosis is fundamentally removing pressure on the spinal cord. Discs in the neck can become arthritis or injured and cause severe compression on the spinal cord itself. This can cause a wide range of symptoms such as pain or numbness in the hands, problems with fine motor function and coordination, issues with balance and dexterity, and several other complications.
Why Cervical Stenosis Surgery?
Cervical spinal stenosis is one of the most misdiagnosed problems I see and treat in my practice. Often, symptoms of cervical stenosis can present away from the neck. Numbness, tingling, and dysfunction in the hands and arms is common. With an accurate diagnosis and proper treatment, surgery can provide healing, prevent symptoms from worsening, and improve your quality of life and function.
- Symptoms are affecting your day-to-day activities
- Your symptoms are becoming more obvious or worsening over time
- Untreated long-term compression of the spinal cord can lead to a serious condition called cervical myelopathy (death of spinal cord cells), which can have irreversible consequences including severe loss of function and eventual paralysis.
- Surgery decompressing the spinal cord is the only effective treatment for moderate to severe cervical myelopathy
- Nonsurgical treatments have proven ineffective
Individuals with cervical stenosis may need surgery present with the following symptoms:
- Pain, weakness, or numbness in the shoulders, arms, hands, or fingers
- Issues with balance and dexterity
- Problems using your hands, including poor coordination, reduced fine motor skills, and dysfunctional or brisk reflexes
- Paralysis in one or more limbs (severe or untreated cases)
- Other bodily function issues, such as incontinence
- Symptoms tend to worsen slowly over time, but may go through periods of remaining stable or rapidly progressing
- Neck pain that is dull or sharp, sometimes accompanied by headaches and stiffness
- Symptoms may flare during certain activities or movements
- Symptoms are most common in patients over the age of 50, but can present in younger patients.
- Symptoms may be confused or misdiagnosed with other conditions (such as carpal tunnel syndrome, peripheral neuropathy, or multiple sclerosis)
Not all patients with cervical stenosis experience neck pain. Some individuals may experience no symptoms their neck at all and just have issues with their hands or balance.
Candidates for cervical stenosis surgery may meet the following criteria:
- Persistent symptoms that have failed conservative treatment
- Symptoms that affect daily life
- Symptoms that are worsening
- Confirmed diagnosis of cervical myelopathy (even mild or currently asymptomatic cases)
- Signs of nerve damage and dysfunction
- Loss of bodily functions, balance, and/or dexterity
Cervical spinal stenosis is often mistaken for other conditions such as carpal tunnel syndrome, cubital tunnel syndrome, multiple sclerosis, vitamin deficiencies, and even just written off to natural aging.
A proper diagnosis requires a detailed medical history and physical examination, as well as advanced imaging diagnostics such as MRI, CT scan X-rays, or electrical studies of the nerves and spinal cord. Clinical indicators during a physical exam may include:
- Increased muscle tone in the legs
- Babinski reflex
- Hoffman reflex
- Difficulty with tandem walking
- Paresthesias and Weakness
Early diagnosis can lead to better treatment results because less damage has been done to the spinal cord.
Surgery for cervical stenosis will relieve pressure on the spinal cord, prevent further damage, and ease symptoms. There are several options for cervical stenosis surgery:
- Anterior cervical decompression and fusion (ACDF): Surgical removal of damaged or degenerative discs that are compressing the spinal cord and fusing one or more levels of the spine together to maintain stability
- Cervical disc replacement: Surgical removal of a damaged disc and insertion of a new artificial disc to provide cushion while maintaining motion
- Cervical laminectomy/Posterior cervical decompression: Removal or restructuring of the lamina and sometimes one or more enlarged facet joints to relieve pressure, possibly with or without fusing one or more levels of the spine
Frequently Asked Questions
“Stenosis” comes from a Greek word meaning “narrowing” or “choking”. Cervical 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.
While all types of surgery present some risks, cervical procedures are relatively safe and effective for appropriately selected candidates. Every patient’s situation is unique and all variables with care are discussed in clinic with Dr Pehler prior to any decisions on surgery.
While surgery is often the only effective treatment for cervical stenosis, there are some nonsurgical treatments that may help patients with mild symptoms and milder compression. Any nonsurgical treatment should be conducted only under the guidance and recommendation of a medical professional.
- Lifestyle modifications: Improving posture, avoiding strenuous activities, and modifying sitting and sleeping positions may improve symptoms.
- Physical therapy: Physical therapy for the neck can improve its strength and flexibility, which may in turn improve posture and reduce the likelihood of painful muscle spasms.
- Medications: NSAIDs and neuropathic pain medications can help relieve inflammation and nerve pain.
- Steroid Injections: Injections can be administered to alleviate inflammation.
Even minor cases of cervical stenosis should be taken seriously due to the potential risks for permanent nerve and spinal cord damage. Having an accurate diagnosis, monitoring, and treatment plan is critical in patients with cervical spinal stenosis.