What Is Cervical Spinal Stenosis? The spinal canal is a long tunnel running down the centre of the spine. This canal sits directly behind the bony blocks, or veterbrae (‘vertebral bodies’) which form the spine (vertebrae) and contains the spinal cord and nerve roots. When the spinal canal is narrowed, the spinal cord and nerve roots may be compressed- this is known as cervical canal stenosis. The spinal nerves (‘nerve roots’) leave the cervical spinal canal by passing through the intervertebral foraminae. The nerves then travel to the arms where they control sensation and movement. When the intervertebral foraminae are narrowed, the nerve roots may be compressed- this is known as cervical foraminal stenosis. In summary, cervical canal and foraminal stenosis are both caused by the same underlying processes, and can present in a similar fashion. The two conditions commonly co-exist and can be broadly referred to as cervical spinal stenosis. What Causes Cervical Spinal Stenosis? As a person ages, or as a consequence of excessive “wear and tear”, a number of processes occur:
The end result of all of this additional tissue formation is that the softest structures in the spine get squashed. Unfortunately, these are the spinal cord and nerves. What Are The Symptoms of Cervical Spinal Stenosis?
Stenosis in the cervical spine can, as pointed out, affect both the:
If spinal nerves are being sufficiently pinched, a radiculopathy may occur and the patient can experience unremitting arm pain, as well as numbness and weakness. When the intervertebral foraminae (‘neuroforaminae’) are reduced in size due to surrounding buildup of tissue, the nerves react to the pressure by swelling thereby causing further pressure on and irritation of the nerves. Compression of the nerves is generally worse when the patient extends the neck (but is sometimes worse when the chin is placed forwards on the chest), and this usually increases the amount of arm pain. Spinal cord compression may result in a myelopathy, with irreversible weakness and loss of muscle bulk of the muscles of the arms, hands and sometimes legs. Also, balance and coordination problems, as well as bowel and bladder incontinence may develop. The symptoms of cervical spinal stenosis may be very mild or even absent even when significant stenosis is present. This is because the spinal cord has the capacity to accommodate to some extent. However, a sudden or severe force such as a car accident or fall can result in severe symptoms in a patient with pre-existing cervical stenosis. The medical term for one such syndrome is ‘central cord syndrome’. How Is The Diagnosis of Cervical Spinal Stenosis Made? In some situations, such as when you are unable to have an MRI, you may also undergo a CT myelogram, where a CT scan is performed after contrast dye is injected into the spinal canal. Shoulder problems may sometimes be confused with pain due to pressure on the nerve roots, and a shoulder ultrasound and/or MRI may be ordered, or an orthopaedic opinion obtained. What Are The Treatment Options for Cervical Spinal Stenosis? Other nonsurgical treatments for cervical spinal stenosis include physiotherapy, chiropractic, acupuncture and osteopathy. Physical therapy can also include the use of heat or ice packs, ultrasound, electrical stimulation, and massage. These treatments can relax tight muscles and ease pain or discomfort. In more severe cases, local anesthetic may be injected around the compressed nerve (transforaminal nerve sheath injection) and can have both diagnostic and therapeutic value. Severe or unresponsive cases of spinal stenosis may require surgery. There are several types of surgery performed to relieve pressure on the spinal cord and nerves, and to help strengthen the spine. These include:
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