Cervical stenosis, also known as Degenerative Cervical Myelopathy, is a condition that occurs in the cervical spine due to the narrowing of the spinal canal. It affects mainly older individuals and is caused by degenerative changes in the discs and bones of the vertebral column.
Introduction to Cervical Stenosis
Overview of Cervical Stenosis
In the neck, there are 7 bones known as the cervical vertebrae, with cushions (called discs) between each vertebra at the front and a joint between each bone at either side at the back of the spinal cord. The mobility of the neck as part of everyday life inevitably means that there is a normal “wear and tear” aspect to the cervical spine as we get older- both in the discs and in the joints. Between each bone there is a space (foramen) for a nerve to leave the spinal canal, which if narrowed means a compression of the nerve (much like in the lumbar spine). One of the problems that can occur in the cervical spine is called Cervical Stenosis or Degenerative Cervical Myelopathy (DCM). Myelopathy means that the spinal cord is compressed. This can occur when the spinal canal is restricted due to degeneration in the discs and bones (stenosis), causing the cord to get narrower.
Who Gets Cervical Stenosis?
Age-related cause of cervical stenosis
Spinal cord stenosis (abnormal narrowing) affects mainly older individuals and results from continuous, very slowly increasing degenerative changes affecting the mobile segments of the vertebral column. The intervertebral discs become less flexible and the small joints between vertebrae become less mobile. These 2 flexible components of the vertebral column try to perform their function despite these changes. Ligaments on both the front and the back of the spine become thicker because they are no longer stretched. The thicker these ligaments become, the more they press on the spinal cord from the front and the back. This pressure leads to a decrease in the blood supply in this area and consequently to the deterioration of the spinal cord function.
Other causes of spinal cord narrowing
Other less common causes of spinal cord narrowing are: fractures, tumours, infections and congenital abnormalities.
Diagnosis of Cervical Stenosis
Symptoms of Cervical Stenosis
Patients with spinal cord problems complain mainly of gradual loss of coordination; i.e. walking and using their hands. For example, they observe that they cannot walk in straight line or button their shirts. Other symptoms include: heavy feeling of the legs and shooting pains in the arms and hands. These may also include local pain in the neck and spasm of the neck muscles.
Medical History and Examination
The doctor will take a history of the illness, and then conduct an examination for weakness and reflexes in the arms and legs, and for any sensation changes.
The diagnosis will be confirmed by performing plain X-rays and a scan (called an MRI) of the cervical spine. The MRI will show exactly how much the spinal canal is narrowed and how much it is affecting the spinal cord.
Treatment of Cervical Stenosis
Mild Cervical Stenosis Treatment
Treatment of the condition depends on the degree of the disease. At the beginning with mild narrowing and tolerable symptoms, the doctor can start with pain medications, physical therapy (e.g. heat packs) and injections.
Advanced Cervical Stenosis Treatment: Surgery
If the condition is already advanced, the best treatment is by surgery. The surgery is done from either from the front or the back of the neck, or both. The decision of which approach depends on how many vertebrae are affected and where is the main location of the narrowing - whether it is the discs in the front of the spinal cord or the joints in the back. This does not make a lot of difference, the main goal of the operation is to provide more space for the spinal cord and to stabilise the cervical spine. After surgery, a neck collar may need to be worn for 1 to 3 months. Afterwards, the spinal cord should be maintained with less pain, but also with slight limitation of motion of the cervical spine.
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