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Cervical Spinal Stenosis

Cervical spinal stenosis describes a narrowing of the spinal canal in the neck with subsequent compression of the spinal cord, mostly as a result of degenerative processes. Ageing or degenerative discs lose their firmness and elasticity, leading to segment instability. The disc protrudes into the spinal canal, causes canal narrowing and affects nerves and/or the spinal cord. In an attempt to stabilize the segment, the body reacts by enlargement of facet joints and thickening of ligaments, which in return cause further narrowing of the spinal canal.

Patients with occasional neck pain do not require treatment. Only if there is radiating pain in one or both arms accompanied by sensory disturbances of the limbs, palsy, bladder and bowel dysfunction, spasticity, gait disturbances or other neurological deficits, a neurosurgeon should be consulted.

Diagnosis

History taking and physical examination is crucial for the diagnosis of cervical stenosis. Flexion-extension X-rays help detecting signs of instability but do not suffice for the identification of the structural causes of a stenosis. Information gained through MRI and CT scans help to illustrate the structural causes of the patient’s symptoms and to aid further treatment decisions. MCT scans allow us to assess nerves and the spinal cord, while a CT helps us to identify bony strictures.

Additional electromyograms, nerve conduction and evoked potential studies help pinpoint nerval or spinal cord damage.

Treatment

The treatment of choice in patients without any neurological deficits consists of conservative treatment including a sufficient pain medication regimen combined with physical therapy. If conservative measures fail to restore the symptoms, a microsurgical decompression of the spinal narrowing may be considered.

Keeping in mind that a cervical stenosis directly affects the spinal cord, surgical intervention should be considered at an early stage in order to preserve the patient’s neurological functionality and prevent worsening of present dysfunctions.

Depending on the type of stenosis, surgical treatment may consist of a complete removal of the pathological disc and its replacement by an artificial disc (“cage”) to achieve ossification and fusion within the segment or its replacement with a disc prothesis. This technique is performed through a cut in the front of the neck.  Another option is approaching the spinal canal from the back of the neck, leaving the disc in place and only removing excessive bony and other tissue that causes the stenosis and therefore widen the spinal canal. This may also include implantation of screws and rods to improve the stability of the spine.

The success of surgery depends on how long the patient has had symptoms prior to the operation and how severe these symptoms were. In some cases, neurorehabilitation after surgery may be senseful.