Cervical stenosis (also called as stenosis in neck or stenosis of neck) is basically the narrowing condition of the spinal canal in the neck.
In general it is an age-related progressive degenerating condition in which the spinal canal narrows down and can squeeze (and even compress) the nerve roots where they leave spinal cord. In worse conditions it may even compress down or damage the spinal cord itself.
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What Are The Causes?
Most of the times stenosis in neck occurs when something happens to reduce the amount of space available within the spine.
Another major cause of cervical spinal stenosis is bony overgrowths which occurs as a result of certain systemic illness like osteoarthritis and paget’s disease.
It has been seen that the soft cushions that act as shock absorbers between the vertebrae tend to dry out with age.
Even a small crack in the exterior of disk may allow the escape of soft inner material causing herniation of discs which compresses the cord.
Abnormal growth of tissues as in case of tumors which forms inside the cord and vertebrae is another important cause to be noticed. Inborn defects (like in people born with small spinal canal) can also be one of the major reasons of this problem.
The tough ligaments that help the bones of spine become stiff and thickened over time. These thickened ligaments can bulge into the spinal canal causing this disease. Spinal injuries as a result of trauma or road traffic accident that results in fracture or dislocations of vertebra also can be a major cause of this problem.
Neck pain which may not be severe all time is the main symptom of neck stenosis. There may be intermittent shooting pains experienced in the arms and legs like an electric shock. Deterioration in fine motor skills such as difficulty in hand writing or buttoning a shirt is another major symptom seen.
Weakness or numbness in shoulders, arms and legs leading to clumsiness. Disturbances in balance and gait along with burning & tingling sensations in extremities may also be there. In severe cases, bladder and bowel incontinence, significant loss of function or paraplegia occurs.
Differential Diagnosis and Diagnostic Tests
The differential diagnosis of stenosis in neck includes many conditions, including congenital conditions such as Achondroplasia and Osteogenesis imperfcta. Degenerative conditions like Osteoporosis and Osteoarthritis are very common.
Inflammatory diseases might include Rheumatiod arthritis of the spine and Anklylosing spondylitis. Other metastatic conditions such as Breast cancer, Prostate cancer etc. are included. Paget disease is also considered.
Various diagnostic tests to confirm neck stenosis may include:
- CT scan and MRI of spine
- X ray of spine: Anteroposterior view, lateral, oblique, and swimmer’s lateral views
- Nuclear medicine’s SPECT bone scintigraphy is valuable primarily in differentiating spondylosis, medical disease, infections and tumors
Best Treatment Options
Most of the times cervical stenosis with myleopathy can be successfully treated with non-operative treatment options such as pain and anti-inflammatory medications.
Medications such as Nonsteroidal anti-inflammatory drugs (NSAIDs), Muscle relaxants, Antidepressants, Anti-seizures, Opioids are prescribed according to the symptoms seen in the patient. Some of the most common and effective cervical stenosis treatment options include:
- Rest or RICE therapy
- Temporary restrictions of neck by using cervical collar or neck brace for a time
- Physical therapy exercises to strengthen and stabilize the neck and to increase its flexiblity
If you have been diagnosed with stenosis in neck, you should exhaust all possible conservative treatment options before actually seeking surgical treatment. These options may include: physical therapy and at home exercises including yoga which helps in alleviating the pain.
Some of the best home remedies for relieving stenosis in neck may include:
- Diet and nutrition for losing excess weight
- using supporters such as canes and walkers while walking to prevent falls
- using pain relievers such as NSAIDs and
- Limiting the use of alcohols and sedatives to improve the condition
Exercises For Cervical Stenosis
While it is tempting to rest (without doing exercises), keep in mind that if you don’t move at all (thinking that laying down will heal your pain) you could actually make your pain worse. By taking this into account try doing some of the best exercises recommended by your physical therapist.
Choose them according to your body type and extremities it can handle and develop a schedule that is doable for you. While implementing them you can take healthy steps every day towards relieving your neck pain due to stenosis. Walking, swimming, water walking, aerobic exercises, physical therapy and yoga are also recommended.
Physical therapy includes passive and active treatments. Passive treatment involves; Deep tissue massage, Hot and cold therapies, Transcutaneous electrical nerve stimulation (TENS) and Ultrasound. Whereas active therapy involves; Posture maintaining, Stretch and flexibility exercises and producing body’s natural pain relievers such as endorphins.
There are some yogic poses that can also help to free up the neck areas resulting the relief in pain. 8-point shoulder opener, Shoulder opener on blocks, Cow face arms, Standing forward fold with shoulder opener, Shoulder opener at wall, Supported fish pose, Thread the needle, Seated spinal twist are few of them.
When Is Surgery Required?
If above parameters don’t work, surgical approach is needed. When all the non-surgical treatments fail to relive and the patient have been in severe pain for a lengthy period of time, one can go for surgery recommended by the doctor.
As such there are number of surgical techniques that can be used to treat this condition. The purpose is to widen the cervical spinal canal and relieve the compression on the cord. Most of the times surgeons use decompression and stabilization methods for stenosis of neck.
Decompression Surgery For Cervical Stenosis
Foraminotomy: It is basically a procedure of making the opening of a foramen larger, so that the nerve can exit without being compressed.
Laminotomy: Similar to foraminotomy. Laminas are bony plate protecting spinal canal and spinal cord. During this condition, lamina may be pressing the nerve. Doing the surgery provides more space for the nerves.
Laminectomy: Sometimes laminotomy is not sufficient. If the condition demands to remove the whole lamina, laminectomy is done.
Indirect decompression is a variation of decompression surgery where bones are spread apart instead of removing it and thereby pressure is relieved. This is achieved through instrumentations or hardware, such as interspinous process devices or interbody cages.
Artificial discs can provide indirect compression to an extent by restoring the height between adjacent vertebrae and are thus tried out.
Stabilization Surgery For Cervical Stenosis
Stabilization surgery is also known as spinal fusion, however it is not required for all spinal stenosis cases. It is more helpful when one or more vertebrae has slipped out from its position, which makes spine unstable and painful.
It can be done alone or along with decompression surgeries. Here, the surgeon creates an environment where the bones of the spine would fuse together over several months or longer by using a bone graft from the same body or a biological substance that will stimulate bone growth.
Spinal instrumentations such as wires, cables, screws, rods and plates etc which increase stability and help in the fusion of bones are also used. The spinal fusion will stop movement between the vertebrae, thus providing a long-term stability. During the surgeries care should be taken to avoid risks such as general risks of anesthesia, Injury to spinal cord or nerves, surgical failure and Infections.
Overall, precautions are better than cure; so avoiding the traumatic causes can be a best for you. Early diagnosis and treatment can provide better management for stenosis in neck and should be your first approach. However it is better to get the surgical help when symptoms turned severe.