Cervical Stenosis
Cervical stenosis (radiculopathy) is the narrowing of the spinal canal (where the spinal cord and nerves originate). Cervical stenosis is most often caused by several factors which combine to cause a critical level of spinal cord compression, at which time symptoms may develop. The neck area of the spinal canal becomes too narrow and compresses the nerve roots or the spinal cord in patients with Cervical Stenosis.
Radiculopathy (compression of the nerves) is distinct from myelopathy (compression of the spinal cord) in several ways.
Radiculopathy typically involves only the pattern of skin and muscles innervated by a single nerve root, while myelopathy can involve the entire arm and hand. Radiculopathy is often unilateral, affecting only one arm, while myelopathy more commonly affects both arms (and can affect the legs as well).
Myelopathy less commonly causes arm pain, while radiculopathy most commonly starts with arm pain. Myelopathy can cause clumsiness of the hands such as changes in handwriting and clumsiness of walking, while radiculopathy usually does not.
Causes
Most people have some changes to their spine by the age of 45. Wear and tear on the spine can change the shape and diameter of the spinal canal over time, causing a gradual loss of spinal structure. This makes age-related changes to the spine the most common cause of cervical stenosis.
These changes include:
- Bulging discs: The aging process can cause the spongy discs that sit between the vertebrae to weaken, and the inner jelly-like core can bulge outward—(herniated disc).
- Bone spurs: Bony growths known as bone spurs can grow on any of the vertebrae of the cervical spine.
- Spinal arthritis: Cartilage that covers the cervical joints can wear down.
In a small number of cases, injury and tumors are responsible for narrowing the spinal canal.
Symptoms
Symptoms depend on the extent of the narrowing of the cervical spinal canal. Compression of the nerve roots can cause:
- Neck pain
- Reduced range of motion
- Numbness in the shoulders and arms
- Neck stiffness
- Tingling in the arms or hands
- Hand clumsiness
- Burning sensations
- Pins and needles sensations
Cervical myelopathy is a serious issue that involves compression of the spinal cord, and it can result from spinal stenosis. Because the spinal cord carries messages to many parts of the body, patients with cervical myelopathy experience a wide variety of symptoms.
In addition to neck pain, patients may experience:
- Loss of balance
- Problems walking
- Bladder problems
- Poor hand coordination
- Problems with fine motor skills
Diagnosis
Imaging tests of the neck such as X-rays, MRI (Magnetic Resonance Imaging and CT scans (computed tomography) are used to confirm the diagnosis.
Treatment
In mild cases, a combination of physical therapy and medication can be used to manage cervical stenosis. Steroid injections are helpful in relieving pain and inflammation in some cases. Decompressive surgery to relieve the pressure on the spinal canal or spinal cord is an effective approach for treating moderate-to-severe cases of cervical stenosis.
If neck pain is chronic and severe, nonsurgical and surgical treatments to relieve pain and restore spinal function are available. For most patients, the acute or severe pain lasts 3-6 weeks and the episode lasts 3-6 months. Initial care often involves one or more of the following:
- Rest
- Avoiding trauma and re-injury
- Cervical immobilization with a cervical brace or collar
- Medications: Non-steroidal anti-inflammatories such as ibuprofen, muscle relaxers, or oral steroids
- Physical therapy, sometimes including cervical traction
- Spinal injections for pain relief: Nerve blocks or epidural steroid injection
- If surgery is ultimately necessary, many insurance carriers require documentation of conservative treatments prior to their approval of surgery. There are several surgical options for treatment, and the physician will select one based on the patient's specific anatomy and pathology.
However, severe weakness related to radiculopathy that is not improving, or is progressive, may prompt surgery even in the absence of conservative treatments. Patients with weaknesses should see a surgeon early during their treatment. If surgery is ultimately necessary, many insurance carriers require documentation of conservative treatments prior to their approval of surgery. There are several surgical options for surgical treatment, and the physician will select one based on the patient's specific anatomy and pathology.
Some examples of surgical procedures include:
Anterior cervical discectomy with fusion (ACDF) is surgery from the front of the neck. The entire disc is removed from the affected level, along with any associated bone spurs, to decompress the spinal cord and nerve roots. The level is then fused with a spacer made up of either bone or a synthetic material and often an anterior cervical plate.
Anterior arthroplasty (artificial disc) is like ACDF surgery. This is an approach from the front of the neck to remove the disc and associated bone spurs. A mechanical artificial disc is placed to preserve motion.