Cervical Stenosis and Myelopathy
Cervical stenosis is the narrowing of the spinal canal which can cause “pinching” of the spinal cord or spinal nerve roots. Spinal cord or nerve function may be affected causing symptoms of cervical radiculopathy or cervical myelopathy. Cervical radiculopathy refers to a loss of function in a specific region within the arm due to irritation and/or compression of a spinal nerve root in the neck. Cervical myelopathy refers to a loss of function in the arms and legs secondary to compression of the spinal cord within the neck. Stenosis does not necessarily cause symptoms. If symptoms do appear, they usually indicate the presence of radiculopathy or myelopathy.
What are Symptoms of Cervical Myelopathy?
Patients with cervical myelopathy may have pain in their neck and arms. Most have symptoms of arm and leg dysfunction. Arm symptoms may consist of weakness, stiffness, or clumsiness in the hands, often manifested by difficulties with fine motor movements such as buttoning clothes and writing, as well as dropping objects. Leg symptoms may consist of weakness, difficulty walking, frequent falls, or the need to use a cane or walker as the disease progresses. Urinary urgency is also common. In late cases, bladder and bowel incontinence can occur.
What are the Causes of Cervical Stenosis?
Cervical stenosis is a degenerative condition that commonly occurs after age 50. Over time, the intervertebral discs that sit between the vertebral bodies of your spine become less spongy and lose water content. This can lead to reduced disc height and bulging of the hardened disc into the spinal canal. The bones and ligaments of the spinal cord thicken, and enlarge, also pushing into the spinal canal. This causes compression of spinal cord and spinal nerves in the neck.
How is Cervical Stenosis Diagnosed?
In addition to your symptoms, cervical stenosis can be diagnosed on physical exam by your treating Primary Care Physician or Neurosurgeon. Your physician may have you obtain diagnostic imaging to aid in confirming the diagnosis. For example, a Magnetic Resonance Imaging (MRI) scan may illustrate a tight spinal canal and pinching of the spinal cord. Also, a Computed Tomography (CT) scan may give clearer information about bony invasion into the spinal canal.
What is the Treatment for Cervical Stenosis
Depending on the severity of your symptoms, a course of non-surgical treatment may be prescribed by your primary care physician or neurosurgeon. This typically involves a combination of medications, physical therapy, and epidural steroid injections.
Medications that are typically prescribed include pain medications to help with your symptoms as well as anti-inflammatory medications, such as ibuprofen, to help decrease inflammation around the nerves in your spine. Occasionally other medications such as Lyrica and Neurontin are prescribed to help with nerve pain.
In addition to medications, a physical therapy program may be incorporated as a form of non-surgical treatment. A physical therapy program usually begins with stretching exercises to restore flexibility to tight muscles in the neck, trunk, arms, and legs. Depending on your response to physical therapy, stretching exercises may progress to cardiovascular exercise and strengthening exercises for your arms, legs, and trunk muscles.
Epidural steroid injections may also be prescribed and involve injection of corticosteroids into the area around your spinal cord and nerves in order to reduce inflammation.
If your symptoms are severe or progressive, or if you fail to respond to non-surgical treatment, surgery may be recommended. Surgery may be done from the front of the neck (anterior) or back of the neck (posterior), depending on the site of worst compression. Surgical treatment involves removing pressure from the spinal cord and spinal nerves (decompression) and will generally include some form of stabilization (fusion) of the affected area. Metal implants (instrumentation) are usually used to support the vertebrae while they heal and fuse together.
Surgical options may include the following:
- Anterior cervical discectomy and fusion (ACDF) – The disc and bone material causing spinal cord compression are removed from the front and replaced with a synthetic spacer. The spine is then stabilized with a small plate and screws.
- Anterior cervical corpectomy and fusion – One or more vertebral bodies and the ligaments compressing the spinal cord are removed and replaced with a synthetic cage. The spine is then stabilized with a small plate and screws.
- Posterior cervical laminectomy and fusion – The bone and ligaments compressing the spinal cord are removed from the back, and the spine is stabilized with screws and rods.
Where Can I Find More Information
North American Spine Society. (2009). Cervical stenosis and myelopathy.