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Spine Problems as We Age: Cervical Stenosis

Lloyd Maliner M.D. Written by Lloyd Maliner M.D.
SeniorLiving.Org Expert on Neurosurgery | Spinal Surgery

Cervical stenosis refers to the narrowing of the spinal canal in the neck. The spinal canal is the central opening in the spine through which the spinal cord and nerves travel on their way from the brain to all points of the body, particularly the arms and legs. An important anatomical concept to understand is that in the cervical spine, as opposed to the lumbar spine, the actual spinal cord is contained in this canal: not just nerves. The spinal cord is an extension of the brain, and is just as delicate and fragile as the brain. An injury to the spinal cord is irreversible and results in permanent damage. Furthermore the spinal cord in responsible for control of the entire body below that level. This means that injury to the spinal cord can result in total paralysis, not just weakness in a finger or toe. So problems like stenosis involving the cervical spine, again unlike the lumbar spine, can result in devastating problems such as quadriplegia.

Cervical Stenosis

The symptoms of cervical stenosis can be subtle and are often missed, even by health care providers. The misleading factor is that often there is no neck pain or discomfort. Patients will commonly respond to the news that they have cervical spinal stenosis with disbelief because they have no neck pain. Usual symptoms include numbness and clumsiness of the hands, and difficulty walking due to balance trouble. If the underlying stenosis is severe and not treated, the spinal cord injury will progress. This spinal cord injury is called myelopathy and can be seen on MRI. The time of progression is variable and can range from months to years. The patients with any worsening of their symptoms are in the greatest danger of rapid decline, while patients without symptoms sometimes will never get worse. However it is impossible to predict an individual patient’s future, so not treating severe stenosis is a risky gamble.

Another important aspect of cervical stenosis to remember is that damage to the spinal cord is permanent. There is often some improvement in the symptoms after surgery, but never complete recovery. This is why treatment of this process is indicated even if the symptoms are not terrible. This is also why it is generally not a good idea to see if the problem is going to get worse. If the patient waits until they can’t walk, then they will always be in a wheelchair despite having corrective surgery. So the risk of waiting and hoping that a person will not get worse is generally worse than the risk of surgery.

The risk of spinal cord damage is compounded by the fact that the spinal cord injury can be instantly worsened by trauma. This means that a car accident or a fall can result in instant and complete paralysis. Remember we are talking about a “disease” of aging, so the scenario is an older patient with balance problems due to cervical stenosis that could become completely paralyzed if they fall: disaster is almost inevitable. Unfortunately it is not uncommon to see just this situation in the emergency room: an older person now paralyzed after a seemingly minor fall. Even sadder is the patient will in retrospect realize they were having the warning signs of cervical stenosis: clumsy hands and balance problems. Now the patient has to undergo emergency surgery with little hope of ever walking again.

The only treatment for cervical stenosis, like the lumbar counterpart, is surgery. There are basically two options for surgery, anterior or posterior. Anterior surgery is the more common and involves an incision on the front of the neck. This procedure involves the removal of cervical discs, and sometimes actual vertebrae, and fusing the involved bones with grafts and plates. As I mentioned, this is the more common procedure and can often be done as an outpatient with fairly fast recovery. Of course operating through the front of the neck and around the spinal cord has many potential complications, but thankfully we have gotten quite good so there are rarely problems. The other option is a posterior approach, or through the back of the neck. This procedure is more like the lumbar counterpart in that a laminectomy is performed, which is to unroof the back of the spinal canal by removing bone. Often screws and plates are placed to strengthen the cervical spine after removal of all this bone. This approach may avoid the critical structures of the throat area, but there are more problems with blood loss and positioning. Even more rarely patients will need to have both an anterior and posterior surgery. There are many discussions amongst spine surgeons as to which approach is best, but the truth is that as long as the surgeon does a good job, they all work well. As with any surgery, every patient is unique so there is no one surgery for all patients. Again it is important to make the diagnosis of cervical stenosis before it is too late.

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