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Cervical Stenosis and Myelopathy
Cervical stenosis is the gradual narrowing of the spinal canal caused by age-related changes of the discs and joints in the neck. This degenerative process is called spondylosis (spinal arthritis). When the stenosis (narrowing) becomes severe, it can lead to compression (pinching) of the spinal cord. Cervical myelopathy refers to neurologic impairment associated with spinal cord compression in the cervical spine (neck). Less frequently, cervical myelopathy can be caused by an acute, large disc herniation with spinal cord compression.
What Causes Cervical Myelopathy?
Cervical spondylosis typically involves degeneration of the cervical discs with progressive narrowing of disc-height and bulging of the discs into the spinal canal. As the discs flatten, bone spurs form that can also protrude into the spinal cord. The spinal canal is also narrowed from behind as the posterior facet joints enlarge, leaving less room for the spinal cord.
Symptoms Of Cervical Myelopathy
- Weakness, numbness or clumsiness of the arms and hands
- Altered walking ability perceived as either poor balance, weakness, heaviness or numbness in the legs
- Painful, stiff neck and variable degrees of arm pain
Progression Of Cervical Myelopathy
The degenerative process that causes myelopathy is typically progressive, causing further compression of the spinal cord as time passes. Neurologic impairment may progress very slowly or rapidly. As the impairment to spinal cord function progresses, both legs weaken and become progressively spastic, making walking more difficult. Bowel and bladder sphincter control may then be altered. The compression of the spinal cord also makes it more vulnerable to injury. In some cases, a simple fall can cause severe spinal cord injury resulting in paralysis.
Diagnosis Of Cervical Myelopathy
The diagnosis of cervical myelopathy is based on the patient's history and the physical findings described above. It may then be confirmed by radiologic imaging, such as an MRI scan of the cervical spine demonstrating spinal cord and nerve root compression.
Non-Surgical Treatment For Cervical Myelopathy
Conservative treatment is aimed at decreasing pain by reducing spinal cord and nerve root inflammation, as well as improving the patient’s function and ability to perform daily activities. Treatment generally consists of temporary immobilization of the neck with a soft cervical collar, anti-inflammatory medications, and physical therapy. Patients with overt spinal cord compression resulting in spinal cord dysfunction may be referred directly for consideration of spine surgery. Failure of the patient to improve after 4 to 6 weeks of conservative management or progression of their symptoms in spite of it, are other indications for surgical evaluation.
Surgical Treatment For Cervical Myelopathy
Surgical decompression of the spinal cord is the definitive treatment for cervical myelopathy. This can be accomplished with various techniques:
- Anterior Cervical Discectomy and Fusion (ACDF)
- Cervical discs are removed through an incision in the front of the neck. The disc spaces are then fused, typically with a bone graft and a small plate that is held to the bone with screws. Learn more about ACDF.
- Cervical Laminectomy
- The “roof” of the spinal canal (lamina) are removed through an incision in the back of the neck.
- The lamina are hinged open to create more room for the spinal cord. Learn more about Cervical Laminaplasty.