Surgical and Post‐Operative Management of Cervical Spine Stenosis

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Definition/Description

Narrowing of the spinal canal in the neck. This can lead to squeezing or compressing of the nerve roots where they leave the spinal cord or it can damage the spinal cord itself. These conditions are referred to as radiculopathy and cervical spinal myelopathy respectively.

Epidemiology/Etiology

Spinal stenosis occurs most commonly in either the lumbar or cervical regions of the spine. Abnormalities that can lead to stenosis are twice as likely to be seen on an MRI in patients over the age of 40; however, stenosis may present without any signs or symptoms. In fact, degenerative changes that manifest in images or scans of the cervical region have been found to not correlate to neck pain.

There are two main types of spinal stenosis:

• Primary: born with a canal that is narrower than most people. Not very common, but usually leads to spinal stenosis in the middle of life.
• Acquired: usually result of disease or injury to the spine such as the causes listed.

Common causes are:

• Age related changes, which include: chronic degeneration, excessive growth of the bones such as osteophytes, destruction of the cartilage, and bulging of the disc.
• Osteoarthritis
• Thickening of ligaments that connect the bones.
• Congenital factors such as Craniodisphyseal Dysplasia3, Achondroplasia, and Paget’s disease of the bone.
• Spinal Tumors
• Spinal injuries causing dislocations or fractures.
  

Examination/Diagnosis

A complete exam including medical history and a neurological screen is essential to determine whether neurological findings exist (either myelopathy or radiculopathy) and whether surgery or other conservative intervention is indicated. Diagnosis of spinal stenosis can only be done with imaging and MRI is the method of choice for diagnosis of spinal stenosis and any possible spinal cord damage.

Primary Complication

Cervical myelopathy is the most common problem that occurs as a result of spinal stenosis. The highest frequency of cervical myelopathy occurs in patients between ages 50 and 60. Signs and symptoms vary but it is usually a slow deterioration process of symptoms and there may be years between onset and first treatment. Neurological symptoms are usually the primary problem that cause patients to seek care. Typical early symptoms are abnormal sensation or motor function of the hand or abnormal gait, especially in the dark. These symptoms are often ignored or unnoticed since they are common comorbidities of aging. As the diseases process progresses, complete loss of hand grasping occurs. Additional symptoms can be numbness and weakness in other parts of the body including arm, leg, or foot. Neck and shoulder pain can occur, but is not common. Lastly, bowel or bladder problems can occur in severe cases of cervical myelopathy.

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