Your cervical spine generally called the neck is composed of a series of bones called vertebrae that are connected. These bones guard the spinal canal that travels through your vertebral column which carries the spinal cord. The spinal cord carries several nerves which are responsible for sensation in your lower and upper limbs and control over bowel and bladder movements.
The connections between the discs, ligaments and muscles provide support, stability and movement to the cervical vertebrae.
Cervical spinal stenosis often termed cervical stenosis. It occurs when the spinal canal in your neck becomes narrow due to degenerative conditions disc prolapse. If the space in your spinal canal is degraded too much, it leads to neurologic deficits which can result in a condition called myelopathy.
How cervical spinal stenosis leads to cervical myelopathy?
Basically, any condition that leads to narrowing of the spinal canal such as bone spurs, disc herniation, or swelling of ligaments might result in cervical stenosis with myelopathy.
The intervertebral discs in your spine that act as a cushion between the vertebral bones become less spongy and dehydrate with increasing age. This results in the reduction of disc height and the disc protrudes into the spinal canal. The bones and ligaments in the facet joints of the cervical spine become thick and enlarged, and also run into the spinal canal. Eventually, the spinal canal becomes narrow which leads to a condition called “cervical spondylosis” or “cervical stenosis.”
Generally, cervical stenosis with myelopathy is referred to as cervical spondylosis with myelopathy or cervical spondylotic myelopathy. Spondylosis is said to be a degeneration condition of the spine, whereas stenosis refers to the narrowing condition of the spinal canal that frequently occurs as a part of spondylosis. As the part of the aging process secondary to the disc prolapse, the patient might develop a disc osteophyte complex at single or multiple levels and they cause the canal stenosis.
Cervical spinal stenosis might occur slowly over time or at a very fast rate. These changes cause the spinal canal to narrow and compress the nerve roots and affect spinal cord function.
Symptoms of cervical stenosis with myelopathy
The signs and symptoms of this condition tend to develop gradually over time, but there are also chances of rapid progression without worsening. The progression of symptoms varies broadly from person to person.
This condition might be asymptomatic in some cases, bit 50% of patients with cervical myelopathy experience neck pain or arm pain. Some have symptoms associated with arms and legs. Which include:
- Clumsiness in hands such as unable to button a shirt, turn the knob of a door or a jar
- Losss of balance and difficulty in walking
- Frequent falls
- Need to use a walker as the disease progresses
- a heavy feeling in the legs
In some patients, urinary urgency is seen. If the cervical stenosis with myelopathy progresses further and compresses the spinal cord, symptoms like incontinence, bladder and bowel movements and paralysis are seen in later stages. Remember, cervical myelopathy typically shows symptoms when your spinal cord is compressed by 30% at least.
In most cases, the condition is diagnosed accurately and surgical treatment is implemented successfully to decompress the spinal cord.
Treatment for cervical stenosis with myelopathy
When the symptoms are minor or barely noticeable, non-surgical treatment might be suggested. But when the symptoms are severe, surgery is the only effective treatment used to decompress the spinal cord.
Non-surgical treatment for Cervical Stenosis with Myelopathy
- Pain medication such as NSAIDs(aspirin or ibuprofen) might provide relief from pain or discomfort.
- Modification in activities – sometimes positioning the neck in a particular position can worsen symptoms. So modifying sleeping positions, maintaining better posture while sitting, and avoiding stressful activities can help to reduce pain and other symptoms.
- Physical therapy and some strengthening exercises designed by a professional physical therapist that targets your neck can improve the strength and flexibility of your neck. They also improve the posture and muscles may have less painful spasms.
However, in case of a primary problem associated with cervical spine (cord compression) physical therapy doesn’t work. Remember that cervical stenosis with myelopathy is a serious condition even in relatively minor cases because the spinal cord which is responsible for sending sensory signals and other signs all over the body is being compressed excessively.
Surgical treatment for cervical stenosis with myelopathy
The goal of the surgery in treating this condition is to relieve pressure on the spinal cord. This is done by extending the spinal canal by eliminating, trimming or by realigning the parts creating the pressure on the spinal cord to compress.
Anterior cervical discectomy and fusion (ACDF) – This is a procedure in which the damaged part of the cervical spine is reached from the front and the herniated discs, bone spurs, and other structures compressing the spinal cord are removed. The procedure also involves fusing one or more levels of the cervical spine to maintain stability.
Posterior cervical decompression – This is a procedure in which the cervical spine is approached from the back, the back of the vertebra, termed as the lamina. In general, either it is removed(laminectomy) or realigned(laminoplasty) to remove pressure on the spinal cord. This procedure may or may not involve a fusion and it totally depends upon the procedure type and the risk of developing instability.Now a days a cervical laminectomy or laminoplasty is accompanied by fixation of the cervical spine with titanium screws. Laminoplasty preserves the motion.
Cervical spinal fusion (arthrodesis) – This is a surgery to combine the selected bones in your cervical spine. It provides stability to the cervical spine.
Surgery for cervical stenosis with myelopathy is a successful procedure for most patients as it prevents symptoms from worsening. The signs and symptoms will go away completely and provide some space to heal. However, the results of the surgery and recovery can vary from person to person. To know more information or having any spine problems, consult Dr Surya Prakash one of the best spine doctors in Hyderabad with more than 24 + years of experience.