Cervical Stenosis: Difference between revisions
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''' | '''Original Editors ''' - [[User:Demol Yves|Demol Yves]] as part of the Vrije Universiteit Brussel Evidence-based Practice Project <br> | ||
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== Definition/Description == | == Definition/Description == | ||
Cervical stenosis is defined by the narrowing of the vertebral canal, which may result in a pinch of the spinal cord and/or the nerve roots. Because of this, the function of the spinal cord or the nerve may be affected, which may cause symptoms associated with [[Cervical Radiculopathy|cervical radiculopathy]] or [[Cervical Myelopathy|cervical myelopathy]].<br> | |||
== Clinically Relevant Anatomy == | == Clinically Relevant Anatomy == | ||
The cervical vertebrae are the smallest vertebrae | The cervical vertebrae are the smallest of the vertebrae, in comparison with the other spinal vertebrae. Their purpose is to contain and protect the spinal cord, support the skull, and enable diverse head movements. In general, the seven vertebrae of the vertebral spine are characterized by a large and triangular verebral foramen and small foramina in the transverse processes (except C7) that allow vertebral arteries, veins and nerves to pass through</ref><ref name="Moore">Moore KL, et al. Essential clinical anatomy. 4th ed. Baltimore, MD: Lippincott Williams and Wilkins, 2011.</ref>. <br> | ||
The ligaments | The ligaments of the cervical vertebrae guide the intra-articular movements in the most optimal directions in order to avoid cartilage damage and muscle hypertonicity. They also prevent excessive movements, which could otherwise lead to serious injuries. The [[Ligamentum flavum|ligamentum flavum]] is a broad, fibrous ligament that connects the laminae of adjacent vertebral arches. The elastic nature of the ligament helps to maintain the natural curvature of the spinal column and protects the intervertebral discs.<ref name="Moore" /><br> | ||
The following muscles act on the cervical spine and help to maintain its balance and stability: <br> | |||
*Longus capitis | *Longus capitis | ||
*Longus colli | *[[Longus Colli|Longus colli]] | ||
*Spinalis cervicis | *Spinalis cervicis | ||
*[[Semispinalis Capitis|Semispinalis capitis]] | |||
There is also a group of muscles that acts to ensure that the head can move in all directions:<br> | |||
*[[Sternocleidomastoid]] | |||
*[[Anterior Scalene|Anterior scalene]] | |||
*Sternocleidomastoid | *[[Middle Scalene|Middle scalene]] | ||
* | *[[Posterior Scalene|Posterior scalene]] | ||
* | |||
* | |||
== Epidemiology /Etiology == | == Epidemiology /Etiology == | ||
Cervical stenosis | Cervical stenosis typically has an insidious onset. The condition is characterized by a narrowing of the spinal canal, nerve root canal, or foramen. Pathological changes to a range of tissues in the region could be at fault. Examples include soft tissue damage (such as disc protrusion or fibrotic scars), boney tissue damage (such as osteophyte formation or spondylolisthesis), or impaired postural mechanics. Narrowing of the canal causes compression of the spinal cord and nerves at the effected level, leading to neurological symptoms as the condition progresses.<ref name="Kisner">Kisner C, Colby LA. Therapeutic exercise: foundations and techniques. 6th ed. Philadelphia: F.A. Davis Company, 2012.</ref> <br> | ||
<br> | <br> | ||
{| width="100%" cellspacing="1" cellpadding="1" border="0" align="center" | |||
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[[Image: | | [[Image:Cervical-Stenosis.jpg|thumb|center|Normal cervical vertebrae]] | ||
| [[Image:Normal-cervical.jpg|thumb|center|300px|Cervical vertebrae with cervical stenosis]] | |||
|} | |||
<br> | <br> | ||
== | == Characteristics/Clinical Presentation == | ||
Cervical stenosis does not necessarily cause symptoms, but if symptoms are present they will mainly be caused by [ | Cervical stenosis does not necessarily cause symptoms, but if symptoms are present they will mainly be caused by [[Cervical Radiculopathy|cervical radiculopathy]] or [[Cervical Myelopathy|cervical myelopathy]]. <br> | ||
The symptoms are:<ref name="1">North | The symptoms are:<ref name="1">North American Spine Society Public Education Series. Cervical stenosis and myelopathy. http://www.spine.org/Documents/cervical_stenosis_2006.pdf (Accessed 22 November 2011).</ref><ref name="2">Williams SK, et al. Concomitant cervical and lumbar stenosis: Strategies for treatment and outcomes. Semin Spine Surg 2007;19(3):165-176.</ref><ref name="3">Countee RW, et al. Congenital stenosis of the cervical spine: Diagnosis and management. J Natl Med Assoc 1979;71(3):257-264.</ref> | ||
*Pain in neck or arms | *Pain in neck or arms | ||
| Line 84: | Line 72: | ||
== Diagnostic Procedures == | == Diagnostic Procedures == | ||
Physical examination: <ref name="1" /><ref name="2" /><ref name="3" /><ref name="4">Santhosh A | Physical examination: <ref name="1" /><ref name="2" /><ref name="3" /><ref name="4">Santhosh A, et al. Spinal stenosis: history and physical examination. Phys Med Rehabil Clin N Am 2003;14.</ref><br> | ||
*Increased reflexes in the knee and ankle, this is called a hyperreflexia, it’s sometimes found with depressed reflexes in the arm | *Increased reflexes in the knee and ankle, this is called a hyperreflexia, it’s sometimes found with depressed reflexes in the arm | ||
| Line 97: | Line 85: | ||
== Outcome Measures == | == Outcome Measures == | ||
See [[Outcome Measures|Outcome Measures Database]] for more | |||
== Examination == | == Examination == | ||
| Line 105: | Line 93: | ||
== Medical Management <br> == | == Medical Management <br> == | ||
In cases with increasing weakness, pain or instability to walk, then is surgical management of | In cases with increasing weakness, pain or instability to walk, then is surgical management of cervical spine stenosis is recommended.<ref name="5">Fassett DR, et al. Asymptomatic cervical stenosis: To operate or not? Semin Spine Surg 2007;19(1):47-50.</ref><ref name="6">Kadanka Z, et al. Approaches to spondylotic cervical myelopathy conservative versus surgical results in a 3-year follow-up study. SPINE 2002;27(20):2205-2211.</ref><br> | ||
Surgical options include anterior decompression and fusion, where the disc and bone material are causing spinal cord compression is removed from the front and the spine is stabilized. The stabilizing | Surgical options include anterior decompression and fusion, where the disc and bone material are causing spinal cord compression is removed from the front and the spine is stabilized. The stabilizing | ||
of the spine, which is called fusion, places an implant between the two cervical segments to support the spine and compensate for the bone and the disc that has been removed. <ref name="1" /><ref name="2" /><ref name="3" /><ref name="7">Boni M | of the spine, which is called fusion, places an implant between the two cervical segments to support the spine and compensate for the bone and the disc that has been removed. <ref name="1" /><ref name="2" /><ref name="3" /><ref name="7">Boni M, et al. The cervical stenosis syndrome with a review of 83 patients treated by operation. Int Orthop 1982;6(3):185-195.</ref><ref name="8">Caron TH, et al. Combined (tandem) lumbar and cervical stenosis. Semin Spine Surg 2007;19(3):44-46.</ref><ref name="9">Engle CA, et al. Cervical stenosis in the athlete. Oper Tech Orthop 1995;5(3):218-222.</ref> | ||
Another surgical option is laminectomy. This is a procedure where the bone and ligaments that are pressing against the spinal cord are being removed. In this treatment the surgeon might add also a fusion to stabilize the spine. <ref name="1" /><ref name="2" /><ref name="3" /><ref name="7" /><ref name="8" /><ref name="9" /> | Another surgical option is laminectomy. This is a procedure where the bone and ligaments that are pressing against the spinal cord are being removed. In this treatment the surgeon might add also a fusion to stabilize the spine. <ref name="1" /><ref name="2" /><ref name="3" /><ref name="7" /><ref name="8" /><ref name="9" /> | ||
After the surgery, the patient has to remain in the hospital for several days. | After the surgery, the patient has to remain in the hospital for several days. A postoperative rehabilitation program may be given, so that the patient can return to his activities and his normal life. <br> | ||
== Physical Therapy Management <br> == | == Physical Therapy Management <br> == | ||
| Line 119: | Line 107: | ||
Nonoperative treatments, such as physical therapy management, are aimed at reducing pain and increasing the function. Nonoperative treatments do not change the narrowing of the spinal canal, but it can provide the patient of a long-lasting pain control and improved life function without surgery. A rehabilitation program may require 3 or more months of supervised treatment. <ref name="1" /><br> | Nonoperative treatments, such as physical therapy management, are aimed at reducing pain and increasing the function. Nonoperative treatments do not change the narrowing of the spinal canal, but it can provide the patient of a long-lasting pain control and improved life function without surgery. A rehabilitation program may require 3 or more months of supervised treatment. <ref name="1" /><br> | ||
A physical therapy or exercise program consists of the following exercises: <ref name="1" /><ref name="9" /> | A physical therapy or exercise program consists of the following exercises: <ref name="1" /><ref name="9" /> | ||
*Stretching exercises, these exercises are restoring the flexibility of the muscles of the neck, trunk, arms and legs. | *Stretching exercises, these exercises are restoring the flexibility of the muscles of the neck, trunk, arms and legs. | ||
| Line 128: | Line 116: | ||
<br> | <br> | ||
There also exists | There also exists a postoperative rehabilitation program for patients who underwent a surgical intervention. <br> | ||
== Key Research == | == Key Research == | ||
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== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | == Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | ||
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== References == | == References == | ||
<references /> | <references /> | ||
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<br> | <br> | ||
[[Category:Vrije_Universiteit_Brussel_Project]][[Category:Cervical_Conditions]] | [[Category:Vrije_Universiteit_Brussel_Project]] [[Category:Cervical_Conditions]] [[Category:Condition]] [[Category:Musculoskeletal/Orthopaedics|Orthopaedics]] [[Category:Cervical]] | ||
Revision as of 03:16, 29 January 2014
Original Editors - Demol Yves as part of the Vrije Universiteit Brussel Evidence-based Practice Project
Definition/Description[edit | edit source]
Cervical stenosis is defined by the narrowing of the vertebral canal, which may result in a pinch of the spinal cord and/or the nerve roots. Because of this, the function of the spinal cord or the nerve may be affected, which may cause symptoms associated with cervical radiculopathy or cervical myelopathy.
Clinically Relevant Anatomy[edit | edit source]
The cervical vertebrae are the smallest of the vertebrae, in comparison with the other spinal vertebrae. Their purpose is to contain and protect the spinal cord, support the skull, and enable diverse head movements. In general, the seven vertebrae of the vertebral spine are characterized by a large and triangular verebral foramen and small foramina in the transverse processes (except C7) that allow vertebral arteries, veins and nerves to pass through</ref>[1].
The ligaments of the cervical vertebrae guide the intra-articular movements in the most optimal directions in order to avoid cartilage damage and muscle hypertonicity. They also prevent excessive movements, which could otherwise lead to serious injuries. The ligamentum flavum is a broad, fibrous ligament that connects the laminae of adjacent vertebral arches. The elastic nature of the ligament helps to maintain the natural curvature of the spinal column and protects the intervertebral discs.[1]
The following muscles act on the cervical spine and help to maintain its balance and stability:
- Longus capitis
- Longus colli
- Spinalis cervicis
- Semispinalis capitis
There is also a group of muscles that acts to ensure that the head can move in all directions:
Epidemiology /Etiology[edit | edit source]
Cervical stenosis typically has an insidious onset. The condition is characterized by a narrowing of the spinal canal, nerve root canal, or foramen. Pathological changes to a range of tissues in the region could be at fault. Examples include soft tissue damage (such as disc protrusion or fibrotic scars), boney tissue damage (such as osteophyte formation or spondylolisthesis), or impaired postural mechanics. Narrowing of the canal causes compression of the spinal cord and nerves at the effected level, leading to neurological symptoms as the condition progresses.[2]
File:Cervical-Stenosis.jpg Normal cervical vertebrae |
Characteristics/Clinical Presentation[edit | edit source]
Cervical stenosis does not necessarily cause symptoms, but if symptoms are present they will mainly be caused by cervical radiculopathy or cervical myelopathy.
The symptoms are:Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
- Pain in neck or arms
- Arm and leg dysfunction
- Weakness, stiffness or clumsiness in the hands
- Leg weakness
- Difficulty walking
- Frequent falling
- The need to use a cane or walker
- Urinary urgency which may result in later cases in bladder and bowel incontinence
- Diminished proprioception
The progression of the symptoms may also vary:
- A slow and steady decline
- Progression to a certain point and stabilizing
- Rapidly declining
Differential Diagnosis[edit | edit source]
add text here
Diagnostic Procedures[edit | edit source]
Physical examination: Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
- Increased reflexes in the knee and ankle, this is called a hyperreflexia, it’s sometimes found with depressed reflexes in the arm
- Changes in the gait such as clumsiness or loss of balance
- Loss of sensitivity in the hand/or feet
- Rapid foot beating that is triggered by turning the ankle upward.
- Babinski’s sign
- Hoffman’s sign
X- rays of the cervical spine doesn’t provide enough information to confirm cervical stenosis, but can be used to rule out other conditions. Cervical stenosis can occur at one level or multiple levels of the spine, therefore is an MRI useful for looking at several levels at one time. It’s also useful to use MRI images because they are very detailed and show the tight spinal canal and pinching of the spinal cord. But a CT scan can give better information about the bony invasion of the canal and can be combined with myelography. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Outcome Measures[edit | edit source]
See Outcome Measures Database for more
Examination[edit | edit source]
add text here related to physical examination and assessment
Medical Management
[edit | edit source]
In cases with increasing weakness, pain or instability to walk, then is surgical management of cervical spine stenosis is recommended.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Surgical options include anterior decompression and fusion, where the disc and bone material are causing spinal cord compression is removed from the front and the spine is stabilized. The stabilizing
of the spine, which is called fusion, places an implant between the two cervical segments to support the spine and compensate for the bone and the disc that has been removed. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Another surgical option is laminectomy. This is a procedure where the bone and ligaments that are pressing against the spinal cord are being removed. In this treatment the surgeon might add also a fusion to stabilize the spine. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
After the surgery, the patient has to remain in the hospital for several days. A postoperative rehabilitation program may be given, so that the patient can return to his activities and his normal life.
Physical Therapy Management
[edit | edit source]
Nonoperative treatments, such as physical therapy management, are aimed at reducing pain and increasing the function. Nonoperative treatments do not change the narrowing of the spinal canal, but it can provide the patient of a long-lasting pain control and improved life function without surgery. A rehabilitation program may require 3 or more months of supervised treatment. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
A physical therapy or exercise program consists of the following exercises: Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
- Stretching exercises, these exercises are restoring the flexibility of the muscles of the neck, trunk, arms and legs.
- Cardiovascular exercises for arms and legs, this will improve the blood circulation of the patient and will also train the endurance.
- Specific strengthening exercises for the arm, trunk and leg muscles.
- Training of activity of daily living (ADL).
There also exists a postoperative rehabilitation program for patients who underwent a surgical intervention.
Key Research[edit | edit source]
add links and reviews of high quality evidence here (case studies should be added on new pages using the case study template)
Resources
[edit | edit source]
add appropriate resources here
Clinical Bottom Line[edit | edit source]
add text here
Recent Related Research (from Pubmed)[edit | edit source]
References[edit | edit source]
