CERVICAL SPINAL STENOSIS

At Southwest Scoliosis and Spine Institute, our board-certified, fellowship-trained orthopedic doctors, have treated thousands of patients with complex spine conditions, including cervical spinal stenosis.

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Cervical Spinal Stenosis

Cervical spinal stenosis is a condition that occurs when the spinal canal in the neck narrows. This can put pressure on the spinal cord and the nerves that branch off from it, causing pain, numbness, and weakness in the arms and hands.  When you come to our offices, you will find that all of the orthopedic surgeons at Southwest Scoliosis and Spine InstituteRichard Hostin, MD, Devesh Ramnath, MD, Ishaq Syed, MD, Shyam Kishan, MD, and Kathryn Wiesman, MD – are all board-certified, and fellowship-trained who together have performed surgery on more than 116,000 patients with scoliosis and other complex spine conditions such as cervical spinal stenosis.

Causes of Cervical Spinal Stenosis

Cervical spinal stenosis usually occurs in older adults as the result of normal age-related causes like wear and tear, as well as conditions such as arthritis, or due to both. Patients in their 50s and above are most commonly at risk for stenosis caused by arthritic changes to the spine. However, it’s important to note that developmental or congenital stenosis can also affect younger individuals, typically in their late teens or twenties and above.
By understanding the range of factors that can lead to spinal stenosis, we can better appreciate the importance of early detection and tailored treatment plans. Whether it’s the gradual impact of aging or congenital conditions, addressing the root causes can significantly improve patient outcomes.

Spine Degeneration

Everyone’s spine experiences some degeneration with age. Intervertebral discs, which provide cushioning between vertebral bones, naturally lose hydration over time and become flatter. These discs may also bulge into the spinal canal. The joints in the back of the spine, called facet joints, degenerate over time and become enlarged due to changes from arthritis. The result of both types of degeneration is less room in the spinal canal, leading to spinal stenosis.  Also, other conditions that can lead to this include:

  • Cervical disc herniation also called neck disc herniation
  • A condition in which one vertebra slips over the one beneath it
  • Bone spurs
  • Injuries to the vertebrae and/or disc(s)
  • Spinal tumors
  • Prior spine surgery

Anything that narrows the spinal canal enough to compress the spinal cord—such as bone spurs, herniated discs, or swollen ligaments—can cause cervical stenosis with myelopathy. While spinal degeneration is typically a slow process that occurs from natural wear and tear over time, it can be accelerated by an injury to the spine.

By understanding these causes and how they contribute to cervical stenosis, you can better comprehend the risks and progression of this condition.

 

Questions and Answers

 

What is Cervical Spinal Stenosis?

Cervical spinal stenosis is a narrowing of the spinal canal in the neck. This can put pressure on the spinal cord and nerves, causing pain, numbness, tingling, and weakness in the neck, shoulders, arms, and hands.

What are the causes of Cervical Spinal Stenosis?

The most common cause of cervical spinal stenosis is age-related wear and tear on the spine. Other causes include:

  • Arthritis
  • Herniated Discs
  • Bone Spurs
  • Tumors
  • Injuries
What are the symptoms of Cervical Spinal Stenosis?

The symptoms of cervical spinal stenosis can vary from person to person. Some people may have no symptoms, while others may experience severe pain and disability. Common symptoms include:

  • Neck Pain
  • pain in the shoulders, arms, and hands
  • Numbness and tingling in the neck, shoulders, arms, and hands
  • Weakness in the next, shoulders, arms, and hands
  • Difficulty walking
  • Balance problems
  • Bladder and bowel problems

Cervical Stenosis

“Cervical Stenosis is a compressing of the spinal cord and nerves in the neck. When we treat this condition, sometimes we recommend exercise and physical therapy, medicines, and sometimes epidural steroid injections. If patients do not respond to these conservative treatments, surgery can open up the space available for the nerves.”

Devesh Ramnath, MD

Cervical Spinal Stenosis Symptoms

Cervical spinal stenosis does not always come with symptoms, especially in cases where the nerves in that area manage to escape compression or the spinal cord is spared from the effects.  However, the symptoms that may come with spinal stenosis differ both in type and severity. Since the narrowing of the canal and compression of the nerve roots is usually a gradual process, the symptoms may not be present or be extreme when this condition first develops.

As it progresses, the pain, weakness, and tingling sensations that come along with it also get more pronounced, the neck pain travels toward other body parts like the shoulders, arms, and even the legs.

The most common symptoms include:

  • Neck pain
  • Numbness or tingling in the hands, legs or feet
  • Muscle weakness in the hands, legs, or feet
  • Difficulty/imbalance while walking or standing
  • Difficulty with fine hand movements
  • In severe cases, loss of bladder or bowel control

Effects of Cervical Stenosis

One of the effects of cervical stenosis is the pinching or compression of nerves in the neck by the cervical spine. This causes burning pain, numbness, weakness, or tingling sensations radiating into the upper body and arms depending on the affected nerves. Thus, specific head or neck movements may worsen the symptoms and the longer they last, they may cause paralysis or become permanent.

Stenosis Spinal vertebraeMore extreme cases of spinal stenosis involve compression of the spinal cord and Cervical Myelopathy indicate wear and tear that aging brings. Eventually, cervical myelopathy can lead to two types of symptoms including the ones felt in the neck as pain and more permanent nerve damage occurring below the region of compressed nerves, which can cause difficulty in walking or maintaining balance. Upon reviewing this condition, doctors notice that it can occur with and without symptoms, but when symptoms do occur, they tend to progress over time.

Pain & Problems Associated With Cervical Stenosis

Pain is one of the hallmarks of nerve damage with this condition. The wear and tear of the cervical spine alongside the narrowing of the spinal canal give rise to symptoms of cervical stenosis including pain. The pain could arise from various sources or different body parts due to nerve involvement.

Neck Pain

Neck pain is a common side effect of cervical stenosis numbness and tingling extending to points below the nerve compression including the arm, hand, legs, and feet.  This may come along with weakness causing clumsiness and balance problems in most people.

Loss of Function

A cause of emotional pain may eminate from the loss of function that affected individuals may experience, which may include the inability to properly use the hands for functions like writing, buttoning, or more.

Loss of Bowel Control

In extreme cases, affected individuals may experience a loss of bladder control and incontinence or even bowel control. This may be due to specific nerve damage associated with spinal stenosis and its effects on the spinal cord.

Diagnosis

Doctors diagnose cervical spinal stenosis by taking a history of your symptoms, performing a physical exam, and ordering imaging tests.  During your history, the doctor will ask you about your symptoms, when they started, and how they have progressed. They will also ask you about any medical conditions you have, any injuries you have sustained, and any medications you are taking.

The doctor will then perform a physical exam. They will check your neck for pain, tenderness, and any deformities. They will also check your reflexes, strength, and sensation in your arms and hands.  During the physical exam, the doctor will check to see if you have any balance problems, as well as any loss of muscle reflexes, loss of sensation, or muscle weakness that may be the result of spinal cord compression.

Imaging Tests

If the doctor suspects that you have cervical spinal stenosis, they will order imaging tests. The most common imaging test used to diagnose this condition is an MRI. An MRI can show the bones, ligaments, and discs in your spine. It can also show any narrowing of the spinal canal.  Other imaging tests that may be used to diagnose cervical spinal stenosis include a CT scan and a myelogram. A CT scan is a series of X-rays that can create a cross-sectional image of your spine. A myelogram is an X-ray that uses a contrast dye to outline the spinal cord and nerves.

Non-Surgical Treatment for Cervical Spinal Stenosis

The treatment for cervical spinal stenosis depends on the severity of the condition and the specific symptoms experienced by the patient. Here are some of the non-surgical treatments for this condition:

Non-surgical treatments:

  • Physical therapy can help to strengthen the muscles of the neck and improve the range of motion. This can help to relieve symptoms of cervical spinal stenosis.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) can help to relieve pain and inflammation associated with cervical spinal stenosis.
  • Steroid injections can help to reduce inflammation and relieve pain associated with cervical spinal stenosis.
  • A cervical collar or brace can help to support the neck and reduce the pressure on the spinal cord and nerve roots.

For early symptoms, activity modification and anti-inflammatory medications are the first line of treatment. Adjusting your daily activities to avoid actions that worsen the symptoms can be very effective. As symptoms progress, more targeted treatments such as epidural steroid injections might be considered to provide relief.

If conservative treatments do not alleviate the symptoms, more invasive procedures like spinal decompression surgery may be necessary. In some cases, depending on the cause and location of the stenosis, spinal fusion surgery might also be required to stabilize the spine and relieve pressure on the nerves. Understanding the progression from non-surgical to surgical options helps in managing spinal stenosis effectively. Always consult with a healthcare professional to determine the best course of action tailored to your specific condition.

Spinal Stenosis Surgery

If non-surgical treatments do not relieve symptoms or if they get worse, your doctor may recommend surgery. When symptoms become more significant, epidural steroid injections can be tried. If none of these give relief, then spinal decompression surgery may be required.

In order to treat cervical spinal stenosis, there are several surgical procedures that relieve spinal cord pressure. For example, the most common surgical procedures for this condition consist of the following by one of our expert doctors:

  • Laminectomy: Removes part of the vertebra to relieve pressure on the spinal cord.
  • Discectomy: Removes a portion of a herniated disc to alleviate nerve compression.
  • Spinal Fusion: Joins two or more vertebrae to stabilize the spine.

By understanding the severity of your symptoms and the effectiveness of non-surgical treatments, your healthcare provider can guide you through the appropriate steps.

Anterior Cervical Discectomy and Spinal Fusion

Cervical spinal stenosis is a condition that occurs when the spinal canal in the neck narrows. This can put pressure on the spinal cord and the nerves that branch off from it, causing pain, numbness, and weakness in the arms and hands.

Progression of Treatment Options for Spinal Stenosis

Before considering surgery, initial treatments for spinal stenosis often include:

  • Activity modification: Adjusting your daily activities to avoid movements that exacerbate symptoms.
  • Anti-inflammatory medications: To reduce inflammation and alleviate pain.

If these early interventions do not provide sufficient relief, more advanced treatments are explored:

  • Epidural steroid injections: These can help reduce inflammation and pain around the affected nerves.

When is Spinal Fusion Surgery Required?

If none of the above treatments provide relief, spinal decompression surgery may be required to alleviate pressure on the spinal cord. Depending on the cause and specific location of the stenosis, spinal fusion surgery might also be necessary. Spinal fusion involves joining two or more vertebrae to stabilize the spine, which can help to reduce pain and prevent further nerve damage.

By understanding the hierarchy of treatment options, patients can better grasp when spinal fusion surgery becomes a viable and necessary option for effectively managing spinal stenosis.

Decompressive laminectomy

In short, this is the most common procedure to correct cervical spinal stenosis.  During this procedure, the surgeon will remove all or part of the lamina from the back of the vertebra.  Sometimes, only a small hole needs to relieve the pressure on the spinal cord.

Foraminotomy

For nerves to pass from the spinal cord to the rest of the body, they use the foramen (a bony hollow archway) as their passageway.  In this procedure, the surgeon cuts a small hole in the vertebra and allows the nerves to pass through the hole to relieve pressure on the nerves and spine.

In addition, these surgeries may even be performed using minimally invasive techniques.  To do this, the surgeon makes a tiny (3 to 15-millimeter) incision and uses special instruments to conduct the surgery.  With minimally invasive procedures, doctors normally allow patients to return to their homes the same day after surgery.

Differentiating Cervical and Lumbar Spinal Stenosis

While cervical stenosis affects the neck, lumbar spinal stenosis occurs in the lower back. This difference in location leads to varying symptoms and affected areas:
Cervical Stenosis:

  • Affected Areas: Arms, hands, legs, and sometimes balance.
  • Symptoms: Pain, numbness, and weakness in the extremities.

Lumbar Stenosis:

  • Affected Areas: Buttocks and legs.
  • Symptoms: Pain, numbness, or weakness, often making standing or walking painful.
  • Additional Impact: This condition can put pressure on the sciatic nerve, making it a chief cause of sciatica.

Understanding these distinctions is crucial for diagnosing and treating spinal stenosis effectively, ensuring that patients receive the most appropriate care for their specific condition.

Why Choose the Southwest Scoliosis and Spine Institute?

The Southwest Scoliosis and Spine Institute Specialists have offices in  DallasPlano, and Frisco, Texas.  Furthermore, the practice is led by a team of highly qualified, experienced orthopedic and spine surgeons.  These surgeons are recognized as the very best by their fellow doctors and surgeons. The doctors are also recognized as leaders in diagnosing and treating the most sophisticated and complex spine conditions.

The orthopedic and spine surgeons at The Southwest Scoliosis and Spine Institute are board-certified, having completed great training at the finest medical institutions in the country.

Each patient’s treatment program is tailored to the patient’s specific needs. Also, we continue to monitor patients with ongoing re-evaluations and adjustments as the recovery progresses. Chiefly, the team offers the most advanced treatment, which combines the latest in cutting-edge technology.  The surgeons prioritize minimally invasive techniques.  However, when necessary the surgeons will use surgery to treat patients and get them back to normal.  The practice welcomes new patients and encourages patients with neck pain to call and make an appointment.

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WebMD: Cervical Spinal Stenosis
Health Central: Cervical Spinal Stenosis

If you or a loved one suffers from spinal pain, you owe it to yourself to call Southwest Scoliosis and Spine Institute at
214-556-0555 to make an appointment.

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