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Cervical Spinal Stenosis

What is Cervical Spinal Stenosis?

A Cervical spinal stenosis is a condition where the spinal canal (tube in the middle of the spine) is narrowed. Since the spinal cord and spinal nerves are located in the spinal canal, this condition can affect them. Unlike in the lumbar spine (low back), the cervical spine has the spinal cord running through its entire length. Therefore spinal stenosis in the neck at any level can compress or irritate the spinal cord or its nerves. However, having the condition of spinal stenosis does not by itself mean that the spinal cord is compressed. In many cases of spinal stenosis, the spinal canal is narrower but does not impact on the spinal cord.

How does Cervical Spinal Stenosis develop?

This condition is quite common as the spine ages. Contributing factors are:

  1. Discs which bulge, protrude, or herniate into the spinal canal from the front.
  2. Bone spurs which develop on the vertebral body or facet joints from the back.
  3. One of the spinal ligaments can thicken (posterior longitudinal ligament) from overuse and also takes up space in the spinal canal
  4. Some patients have a small spinal canal from birth and are at a higher risk to develop spinal stenosis.

What is a Myelopathy?

When spinal stenosis becomes severe, the spinal cord can be significantly compressed. This can result in a condition called a “myelopathy” . A myelopathy is a functional disturbance of the spinal cord. In other words, the spinal cord is compressed to a point where it begins to lose function. This can impair our normal walking, use of our arms and hands, legs and feet, and can cause dysfunction in our bowel and bladder. An untreated progressive myelopathy can permanently injure the spinal cord. This condition often requires surgery.

How much smaller does the Spinal Canal get in a Cervical Spinal Stenosis?

A normal size for a spinal canal in the neck is 17 to 18mm in diameter, about the size of a penny. When the canal narrows to 13mm or less, spinal stenosis exists. When the diameter is reduced to 10mm or less, the stenosis is deemed to be severe with a higher likelihood of causing spinal cord compression.

What are the symptoms of Cervical Spinal Stenosis?

In cases of severe Cervical Spinal Stenosis and Myelopathy some of these symptoms can be seen:

  1. Unstable gait: in severe cases it can look like someone is intoxicated
  2. Weakness in the arms or legs
  3. Weakness in the shoulder muscles
  4. Numbness and tingling in the arms or legs, specifically the hands
  5. Problems emptying the bladder
  6. Problems with controlling bowel movements
  7. Unstable gait
  8. Spasms in the arm and leg muscles
  9. Loss of muscle mass in the arms and legs

How is Cervical Spinal Stenosis diagnosed?

This condition is diagnosed by combining information from the patient history, physical examination, and special tests:

  1. History

The diagnosis revolves around asking the patient questions about some of the common symptoms of spinal stenosis. Here are some:

Do you have a difficult time walking?

  1. Do you feel like you are having problems with your balance? Do you lose your balance if you are in a darker room?
  2. Do you have weakness in the arms? Legs?
  3. Do you have numbness or tingling in your arms or legs?
  4. Do your shoulders feel weak?
  5. Do you have trouble emptying your bladder?
  6. Do you ever lose control over your bowels?

      2. Physical Examination:

The spine specialist often examines the following:

  1. Gait for stability
  2. Reflexes testing
  3. Ankle clonus (link)
  4. Strength testing (motor) of the arms and legs(link)
  5. Sensation testing (sensory) of the arms and legs(link)
  6. Babinski test (link)
  7. Spurling’s test (link)
  8. Lhermitt’s sign (link)
  9. Hoffman’s Sign

 

      3. Imaging

A. X-Ray

X-Rays can be helpful to establish the anatomy of the neck. They can offer some information about the space occupied by the disc, but not directly about the spinal canal or spinal cord.

B. MRI

MRI information is critical when evaluating severe spinal stenosis. It can show the spinal cord and spinal nerves in detail and can accurately assess how much compression of each exists. It can also determine if there is swelling present in the nerve or spinal cord (gliosis). The latter can be a sign of impending damage or existing damage to the spinal cord.

C. CT scan

CT scans can show the spinal canal and foramen accurately. However they have the disadvantage of not being able to show the spinal nerve and spinal cord in detail.

D. CT Myelograms

A CT Myelogram combines a CT Scan with an injection of dye into the spinal fluid. Since the spinal fluid bathes the spinal cord, the dye spreads around the spinal cord. A CT scan can then detect the dye and show if the spinal cord is compressed. However, typically this information is better seen on an MRI. However, there are instances where an MRI cannot be obtained or the spinal cord is obscured by the metal from a previous neck surgery. In these situations, the CT myelogram can be the best study to evaluate the spinal cord.

How is Cervical Spinal Stenosis treated?

The treatment of cervical spinal stenosis is dependent on the severity of the case. Surgery is reserved for severe conditions not responding to non-surgical care.

 

  1. Non-Surgical Care

Here are some non-surgical treatment options:

A. Alternative Health Care

Alternative health care can offer some complimentary options to ordinary medical care. Massage Therapy, Acupuncture, Meditation Exercises as well as Herbal and Aromatherpy Remedies can be helpful.

B. Chiropractic Care

Chiropractic Care can be helpful in patients who have milder cases of Cervical Spinal Stenosis, especially those cases related to misalignment in the neck. In advanced cases, especially those with spinal cord compression, spine manipulation should not be considered.

C. Spine Exercises

Spine Exercises can help maintain muscle tone, strength and mobility in the neck which is often impaired by chronic pain related to Spinal Stenosis.

D. Physical Therapy (PT)

Traction can help with compressed spinal nerves, but not the spinal cord per se. Ultrasound and Electrical stimulation can help with muscle spasms. Certain exercises can help maintain the muscle tone and function.

E. Self Help Devices

Braces can also help with the symptoms from cervical spinal stenosis by keeping the head in the most comfortable position.

A brace may be needed for some cases of spinal cord compression in the neck. It may help to protect the spinal cord from further injury. Motion is restricted to prevent significant forward bending (flexion) for instance, which could potentially increase the pressure on the spinal cord. Other comfort measures include Neck Pillows and Back Support Mattresses which can help alleviate some of the discomfort from Spinal Stenosis.

F. Medications

  1. Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)
  2. Steroids
  3. Muscle Relaxants
  4. Pain Killers
  5. Nerve Pain Medications

G. Injections

Epidural steroid injections can help with cases of cervical spinal stenosis. In cases of severe spinal cord compression, injections may not be recommended

out of fear of compressing the spinal cord further when the needle is placed or the medication is injected. The Spine Surgeon can make the recommendation if an injection is appropriate in these situations.

Here are some available injections for Cervical Spinal Stenosis:

  1. Cervical Interlaminar Epidural Steroid Injection
  2. Cervical Transforaminal Epidural Steroid Injection
  3. Cervical Nerve Root Block

 

      2. Surgical Care

Here are some surgical procedures offered for cases of severe Cervical Spinal Stenosis:

  1. Anterior Cervical Decompression and Fusion (ACDF)
  2. Cervical Artificial Disc Replacement (C-ADR)
  3. Cervical Laminectomy and Fusion