Cervical Spinal Stenosis

Cervical spinal stenosis means a constriction or lack of the usual space for the spinal cord in the neck. The spinal cord is a complex neurological structure running through the spine with longitudinal nerve fiber tracts, exiting nerves and centers of nerve cells all providing important functions for parts of the body at or below the segment in question. The term "spinal stenosis" can sometimes refer to an actual front to back measurement of the spinal canal on X-rays which might suggest the possibility of spinal cord compression without visualizing it directly. Some individuals can have a "congenital" stenosis, meaning that the space in their spinal canal from birth is smaller than in most people. In many instances, the term "spinal stenosis" is used to mean actual spinal cord compression on diagnostic studies relative to the dimension of the cord for that person at other "normal" segments. Herniated Cervical Disc as a cause of spinal cord compression has been discussed on other pages. The term "spondylosis" is also used to describe degenerative changes in the spine with build-up of bone spurs, especially those around the disc spaces and in the direction of the spinal cord.

Cause of Cervical Spinal Stenosis

Cervical spinal stenosis with cord compression can occur due to a number of conditions including the development of bone spurs, calcium deposits or thickening of ligaments. In the vast majority of people, this represents an advanced form of degenerative change in the spine sometimes referred to as "osteoarthritis" or degenerative arthritis. Since these changes take many decades to develop, they are rare in younger individuals. Injuries to the neck usually have uncertain relevance to spinal stenosis and sometimes blend with a long history of variable neck discomfort. However, some people have no significant pain. Occasionally, what compromises the spinal cord is a thickening of the ligament spanning the gaps between the laminae on the back side of the cord. More commonly, there is a build-up of calcium in the ligament running longitudinally across the back sides of the discs and vertebral bodies which compresses the spinal cord from the front. Calcium deposits in this ligament at the very edges of the bodies are called end-plate spurs or "bone spurs" and they can create a "washboard-like" surface in front of the cord. Sometimes, longer sections of the longitudinal ligament can take on calcium and crowd the spinal cord. Mild or moderate distortion of the spinal cord can be tolerated without symptoms in some individuals but others seem more sensitive to spinal stenosis and develop symptoms.

Treatment of Cervical Spinal Stenosis

There are few treatment options for symptomatic cervical spinal stenosis. Excluding disc herniations, the condition has developed slowly over many years or even decades and symptoms have usually been present for months or years at the time patients come to medical attention. Sometimes the symptoms are explained away as poor circulation, arthritis, or muscular deconditioning when they are mild. Conservative physical modalities are generally not helpful when there are neurological features: The two primary options are either surgery or nothing. Symptoms are not expected to rapidly progress unless the person sustains some type of neck injury. Non-surgical management might be reasonable in persons who are still quite functional and who should not have a surgical procedure for other medical reasons.

Surgical decompression of the cervical spinal cord is often performed from the direction of the compression. Posterior approach (from the back) by laminectomy is relatively simple and can treat multiple segments of stenosis. Anterior approach (from the front) can be necessary to remove bone spurs or calcified ligament in front of the cord but possibly involves substantial removal of the vertebral body(s) and a complex reconstruction with bone grafting and bracing afterwards. The best surgical design is judged by the surgeon based on many factors. Frequently, there is more than one segment of spinal stenosis when someone presents for evaluation.

Outcome of Cervical Spinal Stenosis

The results of surgery for cervical spinal stenosis are varied. Treatment of a compressed spinal cord can potentially turn someone who thought he was losing his ability to walk into the relatively independent person he or she used to be. Symptoms involving the arms might also benefit. However, since most persons with cervical spinal stenosis are not young, there can be other simultaneous problems (such as general debilitation, nerve degeneration or Parkinson's disease) which can make the recovery of lost function less than complete. What recovery will occur can sometimes take several months during which time gait training or physical therapy is considered. Recently acquired neurological malfunctions are the most likely to improve quickly and completely. Long-standing malfunctions can take longer and might not ultimately resolve. Impaired walking has such a generally negative impact on a person's health and social status that even a little improvement following an operation can be gratifying. On the negative side, for some reason, certain individuals experience continued neurological deterioration despite technically successful surgery.
Patients who do not choose to have surgery in the context of spinal cord compression also have varied outcomes. Symptoms might not worsen for many years. On the other hand, neurological malfunction can progressively increase until surgery is reconsidered at a later date.

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