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Neck Pain & Arm Pain :: Cervical Radiculopathy :: Cervical Stenosis and Myelopathy :: Cervical Disc Herniation
Cervical stenosis refers to narrowing of the cervical canal to the extent that there is insufficient space for the spinal cord. The most common cause of cervical stenosis is arthritis or wear and tear (called degeneneration). As arthritis advances with aging, a number of structures in the spine (such as discs, joints, ligaments, bones) become "overgrown" and begin to take up more space in the spinal canal, leading to stenosis. At first this stenosis may not cause any symptoms and most patients with cervical stenosis are not aware of its presence. Symptoms begin when the spinal cord gets pinched, and the degree of pinching can determine the severity of symptoms.
Symptoms
Symptoms of cervical stenosis with myelopathy can develop insidiously. The most common finding is gait imbalance. This means patients have difficulty with their balance when walking, feel that they are going to stumble and fall (sometimes patients have several unexplained falls over a period of weeks to months), and occasionally find themselves bumping into walls. At first, this may be very subtle and may not worsen for a long time. But gradually, patients develop more imbalance, and some end up using a cane or sometimes even a walker. Because this condition typically affects older patients, sometimes the difficulty with walking is attributed by patients and family members to "old age". However, there may be a diseased spinal cord that is causing this symptom. As the disease advances and if left untreated, patients eventually end up in a wheelchair and lose the ability to walk.
Another symptom that is present early on is hand "clumsiness". Patients have difficulty with fine motor tasks, their handwriting becomes more sloppy, they have difficulty buttoning shirts, etc. Some patients have numbness in their hands and fingers and cannot feel objects with their fingertips. Some patients also have pain and/or numbness/tingling in one or both arms although pain is not a common finding in this condition. So patients may go undiagnosed for a long time until the spinal cord is damaged. If untreated, patients may lose function of their hands and not be able to care for themselves.
Patients with this problem may have a completely normal physical examination. Some have abnormal reflexes that point to spinal cord compression. But in most cases, significant weakness is NOT present, which again can lead to a delay in diagnosis and timely treatment.
Diagnosis
The best test to diagnose cervical stenosis is an MRI of the cervical spine. This test, along with a thorough history and physical examination, lead to this diagnosis.
Treatment
Of all degenerative conditions that affect the spine, cervical stenosis with myelopathy is one of the few that is not amenable to conservative treatment. There is no role for physical therapy or injections in a patient with severe cervical stenosis who has symptoms of spinal cord dysfunction. Patients with this condition generally deteriorate with time, and surgery is needed to take pressure off the spinal cord. The main goal of surgery is to prevent neurologic worsening. If a patient is already using a cane or walker, the goal of surgery is not necessarily to help the patient walk without these assistive devices. Rather, the goal is to keep the patient walking and not end up in a wheelchair. Especially in elderly patients whose disease is so advanced that they have to rely on assistive devices for walking, surgery is unlikely to return them to their previous state of walking unassisted.
Keep in mind that while the goal of surgery is to prevent further worsening, some (but not all) patients do notice improvement in their function after surgery. The numbness in the hands typically improves (but not completely) and after some time patients note that they can use their hands more effectively.
Surgical options for this problem can be classified into anterior (front) and posterior (back) approaches. There are several factors that determine whether your surgeon will approach your neck from the front or the back. Each approach has certain advantages, and the decision is individualized to each patient. Some patients need surgery from both the front AND back of their neck. The main goals of surgery are to decompress the spinal cord (relieve pressure off the spinal cord) and fuse the cervical spine.
