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cervical_spinal_stenosis

Cervical spinal stenosis

Narrowing of the spinal canal in the cervical spine.

In cervical spinal stenosis, the spinal canal narrows and can squeeze and compress the nerve roots where they leave the spinal cord, or it may compress or damage the spinal cord itself.

Cervical degenerative disc disease is generally discussed in terms of cervical spondylosis, a term which is sometimes used synonymously with cervical spinal stenosis.

Etiology

Cervical spinal stenosis is a defining feature of cervical spondylotic myelopathy (CSM).

Cervical spinal stenosis is usually caused by age-related changes in the shape and size of the spinal canal and so is most common in people older than age 50. The aging process can cause a “bulging of the discs”—the spongy discs between the bones of the spine bulge out farther than normal—or a thickening of tissues that connect bones (ligaments). Aging can also lead to destruction of tissues that cover bones (cartilage) and excessive growth of the bones in joints. These conditions can narrow the spinal canal (spinal stenosis).

In rare cases, the spinal canal is narrowed from birth because of the way the bones are formed.

see Cervical spondylotic myelopathy

see Cervical myelopathy secondary to ossification of the posterior longitudinal ligament

Cervical spinal cord dysfunction can result from either traumatic or nontraumatic causes, including tumors, infections, and degenerative changes.

Association with spinal cord injury

There are few reports regarding surgical management of multilevel cervical spinal stenosis with spinal cord injury.

Clinical features

Squeezing the nerves and cord in the cervical spine can change how the spinal cord functions and cause pain, stiffness, numbness, or weakness in the neck, arms, and legs. It can also affect the control of bowels and bladder.

Many people older than age 50 have some narrowing of the spinal canal but do not have symptoms. Cervical spinal stenosis does not cause symptoms unless the spinal cord or nerves becomes squeezed. Symptoms usually develop gradually over a long period of time and may include:

Stiffness, pain, numbness, or weakness in the neck, shoulders, arms, hands, or legs.

Balance and coordination problems, such as shuffling or tripping while walking. Cervical spinal stenosis can be crippling if the spinal cord is damaged.

Loss of bowel or bladder control (incontinence).

Diagnosis

A diagnosis of cervical spinal stenosis usually is based on your history of symptoms and a physical exam.

Imaging tests that may be used include X-rays, magnetic resonance imaging (MRI), and computed tomography (CT) scans.

In unclear cases of degenerative disorders of the cervical spine, particularly multilevel stenosis, myelography and CT myelogram add relevant information for therapeutic decisions in more than a quarter of the patients in comparison with MRI as the sole diagnostic modality, and changes therapeutic strategies. However, a significant part of the information drawn out of myelography and MCT can be obtained by a completion of noninvasive examinations (native CT and radiographs) 1).

The relationship of the presence, absence or extent of intramedullary T2 weighted signal change to clinical myelopathy, and to the likely outcome after surgery, remains complex and controversial.

More recent publications tend to indicate that T2 weighted signal change, particularly if multisegmental, is a poor prognostic feature for response to surgery.

Scales

Complications

1)
Westermaier T, Doerr C, Stetter C, Linsenmann T, Koehler S, Eriskat J, Solymosi L, Ernestus RI. Influence of Myelography and Postmyelographic CT on Therapeutic Decisions in Degenerative Diseases of the Cervical Spine. J Spinal Disord Tech. 2015 Nov 12. [Epub ahead of print] PubMed PMID: 26566254.
cervical_spinal_stenosis.txt · Last modified: 2018/04/16 13:20 by administrador