The spine consists of the vertebral bodies, intervertebral discs, facet joints, several layers of ligaments. The spinal canal contains and protects the spinal cord and nerve roots. The vertebral column consists of: seven cervical vertebrae, twelve thoracic, five lumbar, the sacrum the coccyx. The intervertebral discs are located in between these vertebrae.
With aging, the intervertebral disc degenerates and narrows. This produces abnormal motion at that spinal level. In an attempt to repair this condition, the spine generates bone spurs and thickened ligaments. This process leads to gradual narrowing of the spinal canal, called spinal stenosis. Spinal stenosis can occur at any level of the spine, however it is most common in the lumbar and cervical spine.
Signs and symptoms of cervical stenosis include a spastic gait, upper extremity numbness, upper extremity and lower extremity weakness, radicular pain in the upper limbs, urinary incontinence, fecal incontinence, muscle wasting, sensory deficits, and reflex abnormalities.
The Causes Of Cervical Foraminal Stenosis
Signs and symptoms of lumbar stenosis include neurogenic claudication (pain in the legs with walking, which is relieved by bending and sitting), leg weakness, leg numbness, and loss of deep tendon reflexes.
The diagnosis of spinal stenosis is made with neuro-imaging modalities. MRI provides the best picture of the spinal cord and nerve roots. If MRI cannot be obtained, CT scan with myelography is an alternative.
Conservative treatment is attempted first, unless there are significant neurological deficits. Rest and anti-inflammatory medications (ibuprofen, Motrin, Aleve) are helpful for mild symptoms. Exercise and physical therapy help rebuild fatigued muscles and encourage proper alignment of the spine. Most find relief with conservative therapy, however progressive pain and weakness are common.
Nine Spinal Stenosis Treatment Options To Help With Pain
For cervical stenosis, several different operations may be applicable. An anterior cervical discectomy and fusion (ACDF) is performed if the majority of the compression is from the anteriorly located intervertebral disc. This procedure involves an incision in the neck, which exposes the spine from the front. The disc is removed relieving any pressure on the spinal cord and nerve roots. Usually, a bone graft is then placed in the space with a metal plate bridging the area.
A modification of this procedure involves actually removing the vertebral body in addition to the disc, followed by placement of a bone graft and metal plate. This is called a corpectomy and fusion.
Recently, artificial discs have been introduced in the treatment of cervical disc disease. A prosthetic disc can be placed into the disc space without having to place a bone graft. This has the advantage of maintaining normal mobility of the neck and, perhaps, preventing degeneration of adjacent levels.
Cervical Spine Surgery
If there is significant compression from the structures in the posterior part of the spine, such as the facets or ligaments, a laminectomy may be performed. This involves making an incision in the back of the neck and drilling away the bony structures covering the posterior spinal canal. The overgrown ligament and bone are removed decompressing the spinal cord. If multiple levels need to be decompressed, then a posterior fusion may be performed, as well.
The most common surgery for lumbar stenosis is a decompressive laminectomy. In this procedure, an incision is made in the back and the lamina (back part of the bone over the spinal canal) is removed to create more space for the nerves.
Using minimally invasive techniques, this procedure can be performed with a small incision, thus allowing for less post-operative pain and a quicker recovery time.
Cervical Spinal Stenosis Video
Occasionally it is necessary to perform a fusion if there is significant intervertebral disc disease or slippage of the vertebral bodies. A fusion permanently connects two or more vertebral bones. Wires, rods, screws, metal cages, and bone grafts may be used to hold the bones in place, while the bony fusion occurs.CERVICAL STENOSIS IS A condition that occurs when there is narrowing (i.e. stenosis) of the passages through which the spinal cord and nerves travel within the cervical (neck) spine. Typically, this narrowing results from an arthritic overgrowth, or spondylosis, of the bones, joints, and ligaments of the cervical spine. Stenosis develops slowly and is progressive. It is more common after 40 years of age. If mild, it can be treated with physical therapy and steroid injections. If severe, it will require surgery to correct such as an Anterior Cervical Interbody Fusion or disc replacement. At Centers for Neurosurgery, Spine, and Orthopedics, our New Jersey team includes world-renowned neurosurgeons, orthopedic spine surgeons, pain management doctors, and physical therapists who provide a comprehensive treatment plan for each patient.
Symptoms of cervical stenosis can be caused either by narrowing of the central spinal canal in the neck (central stenosis) or by a narrowing of the passages where nerve roots exit the spinal canal called the foramina, traveling to the shoulders, arms, and hands. If this region of the vertebra becomes stenosed, it is call foraminal stenosis.
Central cervical stenosis results in the compression of the spinal cord, which is the neural structure that acts as a conduit for signals between the brain and various body parts. When compressed, these signals do not get transmitted properly. Patients with central cervical stenosis usually present with symptoms of spinal cord irritation or dysfunction which includes loss of balance, arm or leg bilateral arm and leg weakness, loss of coordination and can lead to permanent paralysis or quadraplegia.
Risk Factors For Poor Outcome Of Surgery For Cervical Spondylotic Myelopathy
Foraminal cervical stenosis causes a pinched nerve at the level of the spine where it exits the spinal column on its way to the shoulders, arms, and hands. Commonly, foraminal stenosis causes symptoms of pain or tingling sensation shooting down one of the arms. Spasms of the neck and shoulder areas may also occur. Numbness, tingling, burning, and/or cramping sensations may also be felt in the arm, hands, or fingers. More severe cases may cause muscle weakness or loss of muscle tone.
Most cases of cervical stenosis build up over time, as a result of arthritic changes in the bones, joints, and ligaments that surround the spinal cord and spinal nerves. Eventually, these arthritic changes can cause a narrowing of either the spinal canal itself or around the passage (e.g. foramen) where the nerves leave the spine on their way to the shoulders, arms, and hands. Cervical stenosis is commonly seen in people ages 50 and older. Stenosis can be due to other reasons, such as spondylolisthesis, trauma, tumors or fractures, which may cause symptoms to occur in younger age groups.
Through a detailed history, exam, and diagnostic imaging, your doctor can distinguish whether your symptoms are caused by cervical stenosis, or by an unrelated problem such as vitamin deficiency, stroke, or neurologic disorder such as ALS. The cause of symptoms can NEVER be diagnosed from an imaging study such as an MRI alone. The physical examination typically includes:
Multilevel Cervical Spinal Stenosis Wit Double Level Anterior Sur
Depending on what your doctor finds on your exam he or she may make a diagnosis of cervical stenosis. If necessary, your doctor may order further testing to refine the diagnosis.
Most patients improve with conservative treatments, such as structured physical therapy, using a combination of traction, core strengthening, skeletal stabilization, and postural training. These can be performed in combination with medications. With proper physical therapy, muscles around the cervical spine become stronger and help to stabilize the arthritic and inflamed joints that are the underlying cause of cervical stenosis. In addition, physical therapists will teach you how to properly use your neck during daily activities; thereby, reducing stress and inflammation of these joints.
The dedicated team at Centers for Neurosurgery, Spine, and Orthopedics (CNSO) understands how cervical stenosis can impact your daily life. By working with our team of renowned, board-certified neurosurgeons, orthopedic surgeons, non-surgical physicians, physiatrists, rehabilitation specialists, and certified physical therapists, you will receive comprehensive and coordinated care, so you can resume a healthy lifestyle. CNSO offers multiple convenient locations spanning across northern New Jersey, including offices in Bergen, Passaic, Morris, Essex, Hudson, and Sussex Counties. Northern NJ patients can learn more about cervical stenosis by contacting the providers at CNSO today.
How Is Cervical Stenosis Leading To Cervical Myelopathy?
In order to provide an accurate diagnosis with the most effective treatment option for “back problems” and brain tumors, CNSO is led by neurosurgeons and orthopedic spine surgeons. Under the care of our award-winning neurosurgeons and orthopedic spine surgeons, Northern NJ patients can have the confidence that their medical condition will be handled with consideration for their comfort and long-term well-being as well as technical excellence.Anterior cervical discectomy and fusion is a surgery to reduce or eliminate chronic pain in the neck and back due to a problem with the discs.
Anterior cervical discectomy and fusion (ACDF) is an operation to remove a degenerative or herniated disc from the neck. After the surgeon removes the damaged disc, they fuse the bones together.
Between each bone of the spinal column is a cushion called an invertebral disc. These discs prevent the bones from grinding against one another and act as shock absorbers during falls, exercise, and daily activities.
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Sometimes these discs become damaged, causing pain that can range from moderate to intense. An ACDF procedure may be carried out on any of the discs in between the seven cervical bones.
It is easier for the surgeon to reach the spinal column
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