Orthopedics-Online

Spinal canal stenosis in the cervical spine

introduction

At a Spinal stenosis (English "spinal stenosis") is a mostly painful consequence of dying ("degenerative") changes in the spine. All people experience degenerative changes in various structures in the body in the course of their lives. This occurs on the spine bony attachments (osteophytic Attachments), osteoarthritis-like changes in the intervertebral joints and degenerative changes in the intervertebral discs.
These processes can now lead to a Narrowing of the spinal canal, i.e. the canal within the vertebral bodies in which the spinal cord runs and the intervertebral holes (Intervertebral foramina) is coming. The so-called Spinal nerves, the processes of the spinal cord, and can be compressed.

Mainly the lumbar spine is affected, as a lot of forces act on it and it has to carry most of the weight. The spinal canal stenosis manifests itself here in particular through load-dependent lower back pain that radiates into the legs. Those affected can only walk a certain distance without pain (Spinal claudication).
However, spinal stenosis of the cervical spine is also possible. Symptoms in the shoulder and neck region are typical. Movement restrictions and sensory disorders of the arms, but also the legs, are possible. The diagnosis is made using imaging techniques. The MRI, on which the narrowing of the spinal canal can be clearly seen, has priority. Both conservative and surgical procedures are used therapeutically.

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The spine is difficult to treat. On the one hand it is exposed to high mechanical loads, on the other hand it has great mobility.

The treatment of the spine (e.g. herniated disc, facet syndrome, foramen stenosis, etc.) therefore requires a lot of experience.
I focus on a wide variety of diseases of the spine.
The aim of any treatment is treatment without surgery.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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causes

Spinal canal stenosis is primarily the product of years of degenerative processes and changes in the spine. Such degenerative changes occur in every person in the course of his / her life. However, not everyone suffers from spinal stenosis. Whether or not such processes cause discomfort depends on that Extent of change as well as the load on the spine. Degenerative processes lead to a kind of wear and tear or deterioration of tissue, which can lead to functional limitations.

There are various changes in the spine that can lead to spinal stenosis. As part of wear and tear, they form bony attachments, also Spondylophytes called. This is bone tissue that sits on top of the vertebral bodies or the bony forest etchings of the vertebrae. These extensions can Narrow the spinal canal or Nerve roots at their exit points in the intervertebral holes (Intervertebral foramina) compress.

Furthermore, wear and tear of the intervertebral discs lead to a loss of height, they become narrower. Through the Wear of the intervertebral discs there is a greater load on the individual vertebral bodies. Another consequence of the loss of height is a loss of elasticity in the ligaments of the spine, which is less taut. This can lead to the vertebral bodies sliding against each other (Spondylolisthesis).

Last are still A.osteoarthritis-like Changes in Intervertebral joints to call. These joints connect and become the vertebrae with each other Facet joints called. All of these processes gradually lead to it being too Constrictions (Stenoses) at various points of the spinal canal or intervertebral holes comes what is commonly called Spinal stenosis referred to as.

A strong back muscles can helpto stabilize the spine. People who do not have strong back muscles due to a lack of exercise or for other reasons therefore develop such complaints more quickly. Spinal canal stenoses rarely develop in the context of other primary diseases.
Another rare cause of spinal stenosis is a Spinal surgery through excessive Scar tissue After the operation, spinal stenosis of the cervical spine can occur.
Also injuries to the spine or Herniated discs of the cervical spine can lead to spinal stenosis of the cervical spine.

Symptoms

The symptoms of spinal stenosis of the cervical spine differ from those of spinal stenosis of the lumbar spine. Pain in the neck and arms as well as paresthesia in the extremities are typical. This can be, for example, a burning sensation or tingling sensation, but also numbness. Fine motor skills in the hands can be impaired, making fine motor tasks such as writing difficult.
An unsteady gait, like tripping over one's own feet, can also occur in those affected. In the worst case, paraplegia is possible, but this is very rare.

More on this: Symptoms of spinal stenosis

diagnosis

The examination and the patient interview (anamnese) in the case of spinal stenosis of the cervical spine can already provide information about the diagnosis to be made. The Symptoms can be quite typical and thus already point out a suspicion. If a spinal stenosis of the cervical spine is suspected, for example, complaints such as numbness in the arms, a change in the typeface or other abnormalities are queried.
However, further examinations must be carried out to clarify other possible diseases. In the blood test, for example, inflammation values are determined.

Without an imaging diagnosis, however, the spinal stenosis of the cervical spine cannot be reliably determined. Already in X-rays certain changes in the spine are visible. Often the x-ray is called in two planes Initial diagnosis used, whereby it is particularly suitable as a means to clarify other causes such as tumors or a fracture.
The method of choice, however, is magnetic resonance imaging (MRI) of the cervical spine, as it is particularly good at assessing ligaments, nerves and intervertebral discs. Also one CT examination can be quite useful, since bony structures can be assessed particularly well here. This is done, for example, to plan surgery or to better assess the bony processes.

Another exam is the Myelo-CT or Myelography, in which contrast agent is injected into the spinal canal through a puncture needle. By contrasting, narrowing and changes can be better assessed. This examination is particularly important if the MRI or CT did not provide sufficient information for planning the operation. Even if there is a contraindication to an MRI examination, you can switch to a Myelo-CT.

Performing a myelography
MRI with contrast agent - is it dangerous?

Furthermore, a measurement of so-called sensory or motor evoked potentials can give indications of spinal canal stenosis. Using electrodes in the EEG Derived responses that occur to a particular stimulus. For example, muscles or nerves are stimulated. Put simply, damage to the nerve roots by spinal canal stenosis can lead to reduced responses or a longer time to response. In spite of such a finding, imaging is still necessary, as the stenosis cannot be proven.

MRI diagnosis of spinal stenosis in the cervical spine

The main method used to diagnose spinal stenosis is an MRI. Changes in the spine are best seen in these images.

With the help of MRI imaging, also known as magnetic resonance imaging, changes in the Band washers, the Ribbons, the Spinal cord and the annoy or the soft tissues. Spinal canal stenosis can thus be assessed and determined particularly well in the MRI. There may be narrowing of the spinal cord or at the exit points of the nerve roots from the intervertebral orifices. Furthermore, underlying changes in the intervertebral discs, such as a decrease in height, can also be visible. Abnormalities of the ligament apparatus can also be assessed well.
However, this does not mean that every finding in the MRI must also have a consequence. From a certain age, all people show degenerative changes in the spine. The decisive factors are the extent of these changes and the severity of the complaints of these processes.
For a better assessment of the bony conditions in the spine, for example in the case of a planned operation, a CT can be helpful, as it is easier to assess the bony structures.

Please also read our article on this MRI of the cervical spine or MRI vs. CT - What's the Difference?

therapy

Spinal canal stenoses can be treated both surgically and conservatively, i.e. non-surgically, through physiotherapy and other treatment options.

Conservative therapy

In the case of mild complaints, conservative treatment options such as targeted physiotherapy can achieve good therapeutic success.

In the case of spinal canal stenosis, various therapeutic approaches are available to alleviate the symptoms for those affected. First of all, all conservative measures are exhausted before surgical intervention is considered. The therapy follows a versatile approach.
An important component of the conservative therapy of spinal stenosis in the cervical spine is adequate drug-based pain therapy. This is based on a set level scheme that adapts the class of pain medication to the patient's complaints.

Pain therapy has several reasons. On the one hand, it is important to alleviate the symptoms of those affected; on the other hand, it is essential for a good therapy success to prevent pain memory from forming and the pain from becoming chronic. In addition, pain therapy can usually only allow the patient to cooperate further, e.g. for posture training or physiotherapy. The latter is another very important component of the conservative therapy of spinal canal stenosis. The focus here is on exercise therapy and muscle-relaxing procedures.

Some simple exercises to do at home are listed below:

Exercise 1: Stand in front of a mirror for this exercise. Now slide your chin back as if you were doing a double chin. Make the neck very long, so you relieve the compressed structures. Hold this position for 10 seconds and slowly release it. Do not make abrupt movements. Repeat the exercise as you wish.
2nd variation of exercise 1: Grasp the chin with your index finger and thumb and push it back a little further. Do not make any prying movements. Pay attention to a gentle sequence of movements. Hold the position for 10 seconds and release it again.
3rd exercise: Lie on your back and relax your muscles. Now try to press your chin onto your chest as if you were pressing your cervical spine into the ground. Try to relax while doing this. Hold the position for a few seconds, then gently release. Repeat the exercise as you wish.
4. Exercise: Slight shoulder rotations can help relieve pain in the cervical spine and shoulder girdle. While doing this, let your shoulders alternately circle as it feels good to you.

Read about this too Exercises for spinal canal tenosis of the cervical spine

Furthermore, physical therapy approaches such as heat therapy to relax and relieve pain or electrotherapy (also to reduce pain) are used. Acupuncture is also used to reduce pain. Acute relief from the symptoms can also be achieved with a support or back corset.
Another approach is the so-called back school, in which patients learn various techniques for back-friendly behavior and specifically strengthen and strengthen their back and abdominal muscles. Treatment with local anesthetics (local anesthesia) is possible in order to reduce pain and improve the patient's pain. These are injected near the nerve root exit points on the spine and are intended to numb the pain locally.

Do you suspect you have a cervical spine syndrome? To do this, also carry out our self-test "Cervical Spine Syndrome":

Surgery for spinal stenosis in the cervical spine

There are a variety of different surgical procedures used to treat spinal stenosis. Whether or not an operation makes sense depends on the severity and type of symptoms, as well as on the success or failure of conservative measures. The need for surgery should always be carefully considered, considering the advantages and disadvantages for the patient.
If conservative measures are unsuccessful and there are always pronounced or even worsening symptoms, a surgical procedure can be useful.
Patients can benefit from an operation, especially if they have symptoms of paralysis. The various procedures are aimed at relieving the nerve roots and the spinal cord. The following is a compact overview of the most important surgical procedures for treating spinal stenosis:

Laminectomy: Here, parts of the vertebral bodies, the so-called vertebral arches, are generously removed in order to relieve the spinal cord and the nerves emerging from it. The disadvantage is that the spine can become unstable after the operation
Windowing: During fenestration, microscopic holes are made in the area of the vertebral arch and only a little material is removed in order to remove the constriction.
stabilization: In some patients, the spine is so unstable that it needs to be stabilized, for example to prevent vertebral slipping. A distinction is made between fixed fusion, in which vertebral bodies are firmly connected, and dynamic stabilization, in which several vertebral bodies are merely fixed together.

OP risks

As with any operation, surgical interventions to treat spinal stenosis in the cervical spine can be associated with certain risks. One differentiates general Operational risks of special Risks that arise from the procedure.
In general, there is some sort of thing with an operation Risk of infectionby opening the body and introducing material. This risk of infection is increased by the sterile work kept as small as possible in the operating room. Even after the surgery it can become infected Surgical wound come. This risk is also very small, since the interventions with the Keyhole technology carried out so that no large scars occur.
Furthermore, nerves, ligaments, blood vessels and tendons can be injured as part of the procedure. It continues to surrender Risks related to anesthesianecessary for the interventions. Anesthesia can lead to cardiovascular disorders such as a sudden drop in blood pressure or cardiac arrhythmia, which the anesthetist can intercept with medication to support the circulation. It can allergic reaction on the anesthetics used. Furthermore, there may be problems with ventilation. After the anesthesia are Nausea and vomiting possible. Also one confusion is possible, especially in elderly patients.
Through the relief operations and the interventions to stabilize the spine in the case of spinal stenosis of the cervical spine surrounding structures how ligaments, nerves or blood vessels are injured. The spinal cord, which in principle can be injured, is located in the immediate vicinity. However, the risk is very small. This can lead to abnormal sensations, paralysis, numbness or postoperative pain. Furthermore, it can lead to a spinal surgery Spinal instability come This risk is also minimized by stabilizing procedures (see above). During the operation it can lead to the formation of Scar tissue come, which can also cause pain in the region.

forecast

The prognosis of spinal stenosis depends on the extent of the symptoms and the symptoms. Patient with slight discomfort and not so pronounced changes in the spine can already be from one conservative therapy benefit greatly.
Whereas patients with Signs of paralysis or already years of pain mostly just surgically supplied can be. However, even an operation does not guarantee complete freedom from pain. Severe paralysis and numbness cannot always be completely eliminated.
In particular, spinal canal stenoses in the cervical spine can often not be treated completely free of symptoms. In the case of moderate pain and slight sensitivity disorders, however, very good results can often be achieved with a quick start of therapy.