The cervical spine is the top seven bone section attaching to the skull and proceeding through the neck. A canal exists in the spine that protects the spinal cord along its path down into the lumbar spine. This canal when functioning properly will have enough space left over for the spine to not be impinged, or pressured, upon by disc debris or bone spurs.
Problems with the cervical canal
Congenital is a genetic based problem that can occur in spine development causing the canal to not be large enough for the spinal cord to travel freely without compression. Congenital stenosis can occur in some or all sections of the spine and will cause the body parts down stream of the impingement to show symptoms. This stenosis can exist in the spinal cord itself or in the foraminal canals in which nerves leave the cord and innervate into other parts of the body. In the cervical spine the foraminal nerves travel into the arms. In the lumbar spine the nerves innervate into the legs.
Wear and Tear
Cervical stenosis is most often caused by wear and tear such as osteoarthritis during aging. Bone spurs can form thickening the walls of the spinal canal and eventually impinging the spinal cord. Cervical Foraminal Stenosis is the same process but in the foraminal canal of the nerve root innervating off into the body.
Identifying Cervical Stenosis
Anytime there is impingement of the spine there are going to be similar symptoms despite the cause. Cervical stenosis starts off asymptomatic in the early stages. As the disease progresses there may be certain positions that cause a jolt of pain, burning, tingling, numbness, or weakness. The worse the disease gets the more often the symptoms present. If the stenosis is in the foraminal canals the effects can be on just one side of the body unless both foramina are compromised. In the event of the spinal cord being compressed the symptoms can vary based on the level or levels of the spinal cord effected. The effects tend to be more severe such as numbness and weakness, loss of dexterity, balance, or even the ability to hold the bladder or bowls.
X-rays can be useful in seeing disc compression in the spine. In areas of degeneration the bones can start to rub causing the bone spurs that compress the nerves. On transverse views the foraminal canals can be visualized showing their size. If symptoms line up with a narrowed canal on the correct innervation it can be useful for diagnosis.
MRI, or Magnetic resonance imaging produces a three-dimensional image that is a series of thin slices, like frames of video, that can be viewed to identify internal anatomy of in this case the spine. Each vertebrae can have the spinal canal measured and any impingement can be seen. MRI is the most common diagnostic tool used to identify cervical stenosis.
A CT scan also produces a three-dimensional image that is a series of thin slices, like frames of video, that can be viewed to identify internal anatomy of in this case the spine, but unlike MRI which uses a strong magnet, CT utilizes a radioactive element. Each vertebrae can have the spinal canal measured as well as all other anatomical details. CT scans can be diagnostically relevant and the physician’s choice under specific circumstances, but MRI is favored due to the lack of radiation.
Cervical Laminoplasty is a relatively new procedure that involves making the spine canal larger. The patient is placed in a face down position with an incision made on the back of the neck. Tissue is gently pushed aside, and two vertical cuts are made on each effected vertebrae. On one side the cut is partially through the bone leaving a groove, and on the other side the bone is cut entirely through. What is left acts as a hinge along the partial cut. This hinge is used to expand the spinal canal. The interior can be shaved down to remove bone spurs, and while the hinge is in a expanded position bone graft is used to prop the hinge open. Hardware is screwed in to keep everything in place and the surgeon closes the wound. Symptoms are instantly relieved if the spinal cord was undamaged from the impingement. Time is the most relevant indicator of recovery. The longer and stronger the symptoms are tolerated that higher chance that there will be damage. Even if the surgery was not performed in a timely manner most patients get better than they were even if perfect is no longer an option.
Cervical Laminoplasty is similar to having a cervical laminectomy (removal of the bone) but it preserves the bone and there is no need for a spine fusion. It is recommended for younger patients who want to preserve motion but still need a spinal canal widening procedure. It is indicated for congenital cervical spinal stenosis or for patients with multiple levels of disc herniation.
The hospital stay is usually one to two days. No cervical collar is needed after the procedure.