CERVICAL STENOSIS

Cervical spine, illustrationCervical spinal stenosis is a common spine condition affecting patients over 50.  While a common ailment, many doctors will dismiss the symptoms as part of old age.  However, depending on the cause, this condition can get worse over time.  If untreated, it can lead to serious health issues such as loss of bladder and bowel control and/or paralysis.

What Causes Cervical Spinal Stenosis?

Cervical spinal stenosis is a narrowing of the spinal canal inside the vertebrae that make up the neck (known as the cervical vertebrae), and it usually happens gradually as people get older. But in some cases, like those involving trauma, the condition can progress more rapidly. The danger is that as the spinal canal gets narrower, it starts to put pressure on the spinal cord and the nerves that branch off to the parts of the body.

Arthritic inflammation in and around the vertebral joints (spondylitis) is the most common cause. In addition, the discs between our vertebrae wear out as people age (a condition known as degenerative disc disease or spondylosis) and as they do, they can also cause problems for the surrounding tissues in the spine and even slip out of place into the spinal canal themselves (herniated disc). Another common cause is bone spurs, which are bony growths that can start crowding the spinal cord over time.

Types of Spinal Stenosis

There are two main types of cervical spinal stenosis:

  • Primary (Congenital): This form arises from a naturally smaller spinal canal present from birth. Although not very common, it typically leads to spinal stenosis in the middle of life.
  • Acquired: This is due to changes or injuries to the spine, which become more prevalent with age.

Common Causes of Acquired Spinal Stenosis

  • Age-Related Changes: These include chronic degeneration, excessive growth of bones such as osteophytes, destruction of cartilage, and bulging discs.
  • Osteoarthritis: A condition where the cartilage between joints breaks down, leading to pain and stiffness.
  • Thickening of Ligaments: Over time, the ligaments that connect the bones in the spine can thicken and stiffen, contributing to the narrowing of the spinal canal.
  • Spinal Tumors and Injuries: Tumors can develop within the spinal canal, while injuries may cause dislocations or fractures, both of which can lead to stenosis.

Epidemiology

Research shows that abnormalities associated with stenosis are more frequently observed in patients over the age of 40, yet these changes do not always correlate with symptoms like neck pain. This highlights the complexity of diagnosing cervical spinal stenosis based solely on imaging.

Understanding these multifaceted causes and their implications is crucial for managing and potentially preventing cervical spinal stenosis, particularly as we age.

However, spinal stenosis doesn’t only stem from degenerative changes. Traumatic events, such as fractures or instability in the vertebrae, can lead to a rapid onset of this condition. Inflammatory conditions also play a role and can exacerbate the narrowing of the spinal canal. Additionally, tumors can develop within or near the spine, contributing to the constriction of the spinal canal and adding to potential complications.

Understanding these diverse causes is crucial for effective diagnosis and treatment, ensuring that all possible factors are considered to provide the best care.

When the spinal cord becomes compressed, the electrical signals that need to pass through the nerves can get disrupted.  When this happens, it can cause pain, tingling, and numbness in the arms and legs, as well as the loss of muscle control in the areas of the body where these nerves travel.

The most common symptoms of cervical stenosis are:

  • Neck pain (though it’s not always present)
  • Numbness or tingling sensation in the hands, legs, or feet
  • Muscle weakness in the hands, legs, or feet
  • Difficulty with fine hand movements

 

 

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Neck pain, conceptual artwork

How can Cervical Spinal Stenosis go Undiagnosed or Misdiagnosed?

Many of the symptoms of spinal stenosis appear gradually over time, making them difficult to notice. Because of this slow progression, symptoms are often brushed aside by both the patient and a general practitioner as a normal part of getting older. Because the symptoms that accompany stenosis are fairly vague, it takes an expert to identify this condition. Therefore, many diagnoses can misidentify other causes like arthritis, bulging or herniated discs, and even carpal tunnel syndrome.

Cervical spinal stenosis particularly can lead to a range of symptoms due to nerve root and spinal cord compression. These symptoms often depend on the specific level affected. For example, a C5-6 disk herniation can result in C6 radiculopathy. Here are some potential symptoms you might experience:

  • Pain: This can manifest in the neck or arms, often mistaken for other conditions.
  • Motor Dysfunction: Weakness, stiffness, or clumsiness in the hands and legs.
  • Mobility Issues: Difficulty walking and frequent falling.
  • Bladder Control: Urinary urgency, potentially progressing to incontinence.
  • Sensory Changes: Diminished proprioception, affecting balance and coordination.

The progression of these symptoms can vary significantly. Some patients may experience a slow and steady decline, while others might notice a progression to a certain point before stabilizing. In some cases, there may be a rapid decline, necessitating prompt medical evaluation.

Understanding Symptoms

Understanding these symptoms and their progression is crucial for early diagnosis and management, allowing for more effective treatment strategies and better quality of life.

These are just a couple of reasons why it’s so important to see an orthopedic specialist if you have symptoms like the ones listed above.

In addition, X-rays are the first diagnostic tool doctors use to determine what’s going on with the spine, but X-rays don’t always provide the facts in cases of stenosis. This occurs because X-ray imaging can only show issues with the bones of the spine, such as bone spurs, loss of bone height, or spondylolisthesis. They don’t give an accurate view of soft tissue like the spinal cord and nerves. For this, CT and MRI scans are needed.

Advanced Diagnostic Techniques

To accurately diagnose cervical stenosis, medical professionals rely on a range of imaging techniques. Here’s a breakdown of the most effective methods:

  • Extended Release X-ray: While these can show dynamic instability or spondylolisthesis, their value is limited without dynamic views.
  • CT Scans: These are crucial for differentiating between calcified disks and “soft disks.” They also help in identifying ossification of the posterior longitudinal ligament and detecting bone fractures or lytic lesions.
  • MRI: Regarded as the gold standard in diagnosing cervical stenosis, MRI provides a comprehensive view of intrinsic cord abnormalities, the degree of spinal stenosis, and other conditions such as tumors, hematomas, or infections.

For patients who cannot undergo MRI due to medical devices like pacemakers, CT myelogram offers an alternative by identifying the level and degree of stenosis effectively.

By incorporating these advanced imaging techniques, specialists can precisely evaluate and diagnose cervical stenosis, ensuring that patients receive the correct treatment and avoid the pitfalls of misdiagnosis. Therefore, if you suspect symptoms, why not see the very best doctors to ensure a thorough evaluation?

Diagnosis of Cervical Spinal Stenosis

Proper diagnosis of cervical spinal stenosis requires a thorough medical history and neurological examination to determine if neurological findings such as myelopathy or radiculopathy are present. This comprehensive exam is essential in deciding whether conservative treatment or surgery is indicated.

While X-rays are the first diagnostic tool doctors use to assess the spine, they don’t always provide a complete picture. X-rays primarily show issues with the bones, such as bone spurs or loss of bone height, but they fall short in visualizing soft tissues like the spinal cord and nerves. For a more accurate assessment, CT and MRI scans are crucial. MRI, in particular, is the preferred imaging method to diagnose spinal stenosis, offering detailed views that can reveal the condition of the spinal cord and any impinging lesions.

Understanding Conservative vs. Surgical Treatment for Spinal Stenosis

When considering treatment options for spinal stenosis, both conservative and surgical approaches present distinct advantages and disadvantages. It’s crucial to weigh these to choose the best path for your specific circumstances.

Pros of Conservative Treatment

  • Minimal Invasiveness: Opting for conservative treatment in the early stages can prevent the necessity of undergoing a major surgical procedure. This approach typically includes physical therapy, medications, and lifestyle modifications, focusing on facilitating natural healing.
  • Reduced Risk: By avoiding surgery, patients eliminate risks associated with surgical procedures such as infections, complications, or decreased function post-operation.
  • Easier Recovery: Recovery from non-surgical treatments generally involves a less intensive regimen, although it might take longer to see results.

Cons of Conservative Treatment

  • Longer Recovery Time: Since conservative methods rely on the body’s natural healing process, the improvement might be slower, demanding patience and consistent effort.
  • Incomplete Resolution: In some cases, conservative treatments might not entirely resolve symptoms, especially if the underlying issues are severe or complex.
  • Consideration of Medical Conditions: Pre-existing conditions, such as diabetes, need careful management by a multidisciplinary team to ensure the approach is suitable and effective.

Pros of Surgical Treatment

  • Quick Relief: Surgery can offer faster relief by directly addressing the root cause of the stenosis, potentially leading to a quicker resolution of pain and other symptoms.
  • Comprehensive Solution: For significant structural issues, surgery might be the most effective way to achieve substantial improvement or full recovery.

Cons of Surgical Treatment

  • Inherent Risks: Spinal surgery is inherently traumatic to the body and comes with risks, including infections, blood clots, or anesthesia complications.
  • Rehabilitation Required: Post-operative rehabilitation can be extensive and demanding, requiring a detailed and prolonged recovery plan to regain full functionality.

Choosing between these treatments should involve a careful discussion with healthcare providers to consider personal medical history, severity of symptoms, and overall health goals.

Treatment for Cervical Spinal Stenosis

“For most of the patients we see with cervical spinal stenosis, nonsurgical treatments are very successful. More often than not, anti-inflammatory medications and targeted exercises are all they need to start getting relief from their symptoms.” – Dr. Richard Hostin

Conservative Treatment Options

For many patients, a conservative approach is the first line of treatment. This can include:

  • Pain Management: Over-the-counter pain medications often help, and when pain becomes severe, doctors may use epidural steroid injections around affected nerves.
  • Exercises and Physical Therapy: After a brief rest period, physical therapy is often recommended. Exercises aim to strengthen the neck and upper back muscles, improve flexibility, and realign the spine following injuries like a herniated disc.
  • Additional Interventions: Other conservative measures might include immobilization with a cervical collar, use of NSAIDs or muscle relaxants, traction, and cervicothoracic stabilization.

Key Components of Physical Therapy for Cervical Stenosis

  • Stretching Exercises: Focus on restoring flexibility in the muscles of the neck, trunk, arms, and legs.
  • Manual Therapy: Involves cervical and thoracic joint manipulation to maintain or improve the range of motion.
  • Heat Therapy: Helps improve blood circulation to muscles and soft tissues.
  • Cardiovascular Exercises: Enhance blood circulation and promote cardiovascular endurance through targeted exercises for the arms and legs.
  • Aquatic Exercises: Allows body movement without exerting pressure on the spine.
  • Training for Daily Activities: Includes learning functional movements and techniques to manage everyday tasks effectively.

Preventive Techniques

To help manage symptoms and prevent the progression of cervical stenosis, consider incorporating the following:

  • Specific Strengthening Exercises: Target arm, trunk, and leg muscles.
  • Postural Re-education: Helps maintain proper alignment and alleviate stress on the spine.
  • Scapular Stabilization: Supports the back and neck, promoting better posture.
  • Ergonomics: Ensure frequent changes in position to avoid sustained postures that may compress the spine.
  • Activity Planning: Plan breaks during potentially back-stressing activities like walking or yard work.
  • Proper Lifting Techniques: Learn proper methods for lifting, pushing, and pulling to minimize strain on the back.

Through a blend of these exercises and techniques, physical therapy can effectively manage cervical stenosis symptoms, offering a path to a more comfortable and active lifestyle.

Surgical Approach

At the Southwest Scoliosis and Spine Institute, our philosophy of care prioritizes minimally invasive options before considering traditional surgery. We’re specially trained and equipped to perform these kinds of procedures, and our patients get back to their daily routine faster as a result.” – Dr. Richard Hostin

If nonsurgical methods do not work to relieve pain and other symptoms, or if the pain begins to worsen, surgery may be suggested. Surgical procedures for spinal stenosis aim to relieve pressure on the spinal cord and nerves. Minimally invasive decompression surgery is often preferred, as it involves smaller incisions (3- to 15-millimeter) and offers benefits such as:

  • Less bleeding
  • Less scarring
  • Faster recovery time
  • Less pain

These procedures are usually performed on an outpatient basis, allowing most patients to return home the same day as their surgery.

Understanding the comprehensive diagnosis and treatment options for cervical spinal stenosis is crucial for managing this condition effectively. With expert guidance and the right approach, many patients achieve significant relief and improved quality of life.

Surgical Techniques

While minimally invasive techniques are gaining popularity due to their numerous benefits, it’s crucial to understand the broader scope of surgical approaches available for cervical spinal stenosis. Surgery aims primarily to decompress the spinal cord by removing any space-occupying lesions, such as osteophytes or disk protrusions, and to neutralize any instability present. This comprehensive approach ensures targeted relief, addressing the specific needs of each patient.

Despite the promise of surgical intervention, it’s important to note that research on the absolute advantages or disadvantages of surgery is still evolving. Although minimally invasive methods show significant promise, current evidence highlights the need for further high-quality studies to substantiate these findings thoroughly.

Ultimately, the choice of procedure depends on the patient’s specific condition and severity, with the overarching goal of preventing the progression of myelopathy and improving neurological deficits. Whether opting for minimally invasive or other surgical options, the focus remains on enhancing patient outcomes with the least amount of disruption to their lives.

Outcome Measures for Assessing Cervical Stenosis

When evaluating cervical stenosis, healthcare professionals utilize specific outcome measures to assess the severity and impact on a patient’s daily life. Here’s a closer look at these key tools:

Neck Disability Index (NDI)

  • This is a widely used questionnaire that helps measure a patient’s neck-specific disability.
  • It evaluates the impact of neck pain on various activities such as personal care, lifting, reading, and work.
  • Patients rate ten different areas on a scale, providing a comprehensive view of their condition.

Neck Pain and Disability Scale (NPDS)

  • This tool captures both the intensity of neck pain and the degree of resulting disability.
  • The scale consists of visual and numerical components that patients complete, offering insight into pain levels and functional limitations.
  • It’s particularly useful for tracking progress over time, as it clearly highlights changes in pain and disability.

Utilizing these outcome measures allows clinicians to tailor treatment plans effectively, track improvements, and facilitate communication with patients about their condition and treatment goals.

Understanding the Prognosis for Cervical Stenosis

Cervical stenosis, often associated with aging, can vary in its impact on each individual. Although most people may experience some discomfort or pain related to the spine, the good news is that surgical intervention is not always necessary. In fact, the majority of patients with cervical stenosis tend to recover well and lead normal lives with appropriate management and lifestyle modifications.

Key Points to Consider:

  • Pain and Recovery: While pain is a common symptom, it is generally manageable for many. Most individuals recover without significant complications.
  • Incidence of Complications: A small percentage, around 1-3%, may develop a herniated disc, with fewer than 2% experiencing nerve root compression.
  • Aging and Symptom Development: As people age, spinal narrowing becomes more common. However, predicting whose condition will become symptomatic is challenging.
  • Lifestyle Management: Successful management often includes lifestyle changes such as exercise, postural adjustments, and physical therapy, which can help control the degenerative process and improve quality of life.

Understanding this prognosis helps in planning care and making informed decisions about treatment options.

How Effective is Rehabilitation Following Surgery for Spinal Stenosis?

Rehabilitation plays a crucial role in recovery for patients who have undergone surgery for spinal stenosis. According to a Cochrane review, engaging in active rehabilitation significantly enhances recovery compared to conventional care.

Key Findings:

  • Improved Functional Status: Patients participating in active rehabilitation experienced approximately a 20% boost in their functional status post-surgery.
  • Pain Reduction: Short-term improvements were notable, with a 16% reduction in low back pain within the first six months. Moreover, there were long-term benefits observed 12 months post-surgery, including alleviated back and leg pain.

Components of Active Rehabilitation:

Active rehabilitation encompasses a range of activities designed to restore function. These include:

  • Exercise Programs: Strength and flexibility training are central to the rehabilitation process.
  • Stabilization Training: Techniques aimed at improving core stability and physical function.
  • Education and Encouragement: Informing and motivating patients towards an active lifestyle post-surgery.

Overall, the evidence suggests that active rehabilitation is highly effective both in the short and long term, facilitating a better recovery process by enhancing functional capabilities and alleviating pain.

In Conclusion

Spinal stenosis can significantly diminish one’s quality of life as time progresses. Initially, individuals may experience persistent pain and muscle weakness, which can gradually intensify. This chronic discomfort often restricts mobility, making everyday activities increasingly challenging.

One profound impact of spinal stenosis is on a person’s ability to walk. Many individuals develop gait disturbances, struggling with balance and coordination. In more severe cases, the condition might evolve into cauda equina syndrome, a neurological emergency requiring immediate intervention.

Unfortunately, while some people might see slight improvements, most experience a worsening of symptoms, potentially leading to permanent disability. This ongoing decline not only affects physical capabilities but can also impact mental well-being, as individuals grapple with the limitations imposed by their condition.

Financially, the burden of managing spinal stenosis can be overwhelming. Ongoing medical treatments, therapies, and potential surgeries contribute to substantial healthcare expenses, placing a significant strain on patients and their families. This financial stress adds another layer of complexity to coping with the condition, highlighting the multifaceted ways spinal stenosis can alter one’s life over time.

Getting an Evaluation and Treatment for Cervical Stenosis at the Southwest Scoliosis and Spine Institute

If you have any of the symptoms listed above and you think you may have cervical spinal stenosis, it’s important to see an orthopedic spine specialist like those at the Southwest Scoliosis and Spine Institute, which has offices in DallasPlano, and Frisco, Texas.  

All of our orthopedic surgeons, Richard Hostin, MDDevesh Ramnath, MDIshaq Syed, MDShyam Kishan, MD, and Kathryn Wiesman, MD, have expert experience in diagnosing and treating complex spine conditions like cervical spinal stenosis.

If you are in pain and think you suffer from cervical spinal stenosis, we can help. Call us to make an appointment at (214) 556-0555 or visit our contact page today.

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Health Central: Cervical Stenosis
American Academy of Physical Medicine: Cervical Stenosis

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