Cervical Spine Stenosis
Cervical Spine Stenosis (CSS) is a degenerative disease that most often happens over time, with years of wear and tear. This is more commonly referred to as arthritis of the spine. The spinal canal and neural foramen narrow and compress the spinal cord and nerve roots. Stenosis occurs when pressure increases inflaming the facet joints. Studies show that we can start the degenerative process, depending on how well we take care of our bodies, as early as our 30s. Genetics and congenital factors can predispose a person for stenosis. Usually the very severe symptoms don’t show until age 60 and older. Other causes of CSS include cervical spondylosis and diffuse idiopathic skeletal hyperostosis (DISH), or calcification of the posterior longitudinal ligament.
The Cervical Spine
The cervical spine is made up of the first seven vertebrae in the spine. The first two vertebral bodies in the cervical spine are called the atlas and the axis. The cervical spine is much more mobile than the thoracic (mid-back) or the lumbar (lower-back).
Because of constriction and inflammation it may cause symptoms of shooting pain, that may feel a little like an electric shock. This can be especially so if you flex your neck and tip your chin to your chest. Other sensations may include numbness, tingling, weakness, burning, and pins and needles in the involved extremity.
Your Consultant will have to do testing because these types of symptoms can also be due to other problems such as disc herniation.
Stenosis is a chronic, progressive process that can have episodes of worsening.
Most often the best diagnostic tool is MRI (Magnetic Resonance Imaging). With this method you don’t have the concern of radiation exposure found with X-Rays. X-Rays are still used in some cases. MRI can also determine whether or not the spinal cord is narrowing and where the narrowing is occurring, the degree of the compression, and any nerve roots that may be involved. After the diagnosis is made, a plan of treatment can be implemented.
That depends on the severity of the diagnosis and the particular individual patient. If the diagnosis is a mild problem, the physician may implement physiotherapy (which may include water therapy) and/or the use of a cervical collar. The treatment plan could also include anti-infammatory and analgesic medications to help control and lessen inflammation and pain. The exact physical therapy regimen would have to be decided by your Consultant along with a physical therapist. If the diagnosis is a severe form causing a lot of other physical problems, then most probably you’ll be looking at surgical options.
This depends on the severity and the individual patient. The Consultant looks at other health concerns and age in each patient since there are risks in all surgical procedures. Some options include:
- Laminectomy. A surgical procedure to remove a portion of the vertebral bone called the lamina. The minimal form of the procedure requires only small skin incisions, the back muscles are pushed aside rather than cut, and the parts of the vertebra adjacent to the lamina are left intact. Recovery from the minimal procedure can occur within a few days
- Anterior Cervical Disectomy. An operation where the cervical spine is reached through a small incision in the front of your neck. After the soft tissues of your neck are separated, the intervertebral disc and bone spurs are removed.
- Anterior Cervical Disectomy with Fusion. An operation performed on the upper spine to relieve pressure on one or more nerve roots and/or the spinal cord. The term is derived from the words anterior (front), cervical (neck) and fusion (joining the vertebrae with a bone graft).
- Foraminotomy. Surgical opening or enlargement of the bony opening traversed by a nerve root as it leaves the spinal canal. A procedure carried out alone or in conjunction with disc surgery.
- Corpectomy. Excision of vertebral body usually combined with interpostion of prosthesis or bone graft.
- Laminoplasty. The lamina are hinged laterally and opened like a door, and secured in their new position with suture or bone to enlarge the spinal canal.
- Cervical Fusion. It involves the stabilization of two or more vertebrae by locking them together (fusing them). The fusion stops the vertebral motion and as a result, the pain is also stopped. Trauma and degenerative disc disease (DDD) can cause a need for this type surgery. This procedure can take 2 to 6 hours to perform, depending on the number of vertebrae involved. One of the risks involved in this procedure is that the bone graft may not take. This also leaves the patient with less mobility of the neck. This is one reason why physicians are now looking at Cervical Disc Replacement or Artificial Disc Replacement.
- Artificial Disc Replacement. A surgical procedure in which degenerated intervertebral discs in the spinal column are replaced with artificial devices in the lumbar (lower) or cervical (upper) spine. The procedure is used to treat chronic, severe low back pain and cervical pain resulting from degenerative disc disease. Artificial disc replacement has been developed as an alternative to spinal fusion, with the goal of pain reduction or elimination, while still allowing motion throughout the spine. Another possible benefit is the prevention of premature breakdown in adjacent levels of the spine, a potential risk in fusion surgeries.