Spinal stenosis (narrowing) at the level of the cervical spine is a condition that can lead to compression of the spinal cord or nerve roots and disruption of their function, which is accompanied by corresponding symptoms (within the framework of cervical radiculopathy or cervical myelopathy).
Spinal stenosis can occur due to spondylosis (degenerative changes in the cervical spine), as well as due to trauma (fractures and instability), inflammatory processes, intervertebral hernias and tumors.
Anatomy
Normally, the spinal canal has enough space for all neural structures. The diameter of the spinal canal depends on the level and individual characteristics. For example, the height of the body of the third cervical vertebra (C3) is about 21.8 mm and the spinal cord occupies about 50% of the spinal canal. The height of the C6 vertebral body is 17.8 mm and the spinal cord occupies about 75% of the spinal canal.
Lee et al. described the mean anterior-posterior distance within the spinal canal (and acceptable deviations) in all samples and at all levels. It is 14.1 +/- 1.6 mm. The minimum diameter is 9.0 mm, maximum 20.9 mm, average 14.4 mm. In men, the diameter of the spinal canal at all levels is greater than in women.
Although congenital narrowing of the spinal canal is possible, most often the stenosis is acquired. It is formed as a result of progressive degeneration of the intervertebral disc, which may be accompanied by the formation of protrusion, ventral osteophytes, thickening of the ligamentum flavum and hypertrophy of the facet joints.
Meyer et al. described how movements change the diameter of the spinal canal and spinal cord. The diameter of the spinal canal decreases with flexion and extension. During extension, the ligamentum flavum forms folds, which leads to a narrowing of the spinal canal. In addition, changes in the length of the spinal cord also affect the diameter of the spinal canal. For example, shortening of the spinal cord during extension results in an increase in the diameter of the spinal canal. If spinal stenosis occurs, the spinal cord may be damaged during movement. It can be compressed between the posteroinferior part of one vertebral body and the arch or ligamentum flavum of the underlying segment. This mechanism causes not only damage to the spinal cord, but also to the vessels that supply it. Firstly, the anterior spinal artery may be compressed, and secondly, compression of the spinal cord leads to twisting of the transverse grooves in which other arteries lie. These vessels supply the gray matter and medial white matter, which are primarily affected.
Causes of development of spinal canal stenosis
People who have crossed the age of 50 are more often susceptible to pathology. If stenosis is diagnosed earlier, the cause is a congenital malformation in one or more vertebrae. Stenosis in this case is defined as primary. Secondary stenosis is caused by:
- arthrosis of the facet joints;
- growth of osteophytes;
- changes in the ligamentum flavum in the form of compaction;
- protrusion;
- injuries;
- epiduritis;
- lipomas;
- spondylolisthesis;
- spondylosis;
- osteochondrosis.
Epidemiology
Spinal stenosis is quite common. It has been estimated that in the adult population, cervical spinal stenosis occurs in 4.9% of people, of which 6.8% are people 50 years of age or older, and 9% are people 70 years of age or older. For most patients, symptoms worsen with age. The deterioration sometimes increases quickly and is irreversible. 75% of people suffer from neurological deficits. There is evidence that about 5% of people who do not have symptoms of spinal cord compression worsen each year. There are also patients with acute disease. As a rule, these are people with pronounced but asymptomatic stenosis, which begins to appear after a minor injury.
Spinal stenosis most often leads to spinal cord myelopathy in people aged 50+ years.
Clinic
Cervical stenosis does not always cause symptoms, but when they do occur, they are always associated with cervical radiculopathy or cervical myelopathy. The following symptoms may occur:
- pain in the neck and arms; - dysfunction of arms and legs; - weakness, stiffness or clumsiness in the hands; - weakness in the legs; - walking impairment; - frequent falls; - increased urge to urinate, which can lead to incontinence; - violation of proprioception.
The progression of the disease can occur in different ways:
- slow and constant deterioration; - deterioration to a certain point and stabilization; - rapid progression.
How to make an appointment with a vertebrologist, neurologist
At the first symptoms of the disease, you need to go to the appropriate specialist: a vertebrologist, a neurologist. In the central district of Moscow, you can make an appointment with a doctor at JSC “Medicine” (clinic of Academician Roitberg), which is located near the Belorusskaya and Mayakovskaya metro stations. You can get to the medical center from the Novoslobodskaya metro station, and the Tverskaya metro station and Chekhovskaya metro station are also within walking distance.
If you doubt your diagnosis, then first you can visit a therapist, who, after an examination, will give a referral to the appropriate specialist at the clinic in the Central Administrative District: a vertebrologist, a neurologist.
You can make an appointment through a special application form, which is available on the clinic’s website. You can also do this by calling: +7 (495) 775-73-60. We are located at the address: Moscow, Central Administrative District, 2nd Tverskoy-Yamskaya lane 10. There is also the possibility of a consultation appointment, where you can receive all the recommendations for preventing the development of the disease.
Diagnostics
X-ray is not informative enough to confirm spinal stenosis, but can be used to exclude other pathologies. Stenosis can occur at one level or at several levels simultaneously, so the use of magnetic resonance imaging is justified. MRI clearly visualizes stenosis and compressed spinal cord. Computed tomography (CT) is informative regarding bony narrowing of the spinal canal and can be used in combination with myelography.
If the spinal cord or spinal roots are not compressed, then stenosis in the cervical spine may exist asymptomatically (for the patient). However, if you conduct a complete neurological examination, you can identify some neurological symptoms:
— hyperreflexia: increased tendon reflexes (knee and Achilles); - changes in gait (awkwardness or imbalance); - loss of sensation in the arms and legs; - Babinsky's symptom; - Hofmann's symptom.
Prevention
To slow down the progression of the disease, you should choose the right special exercises.
Every day you should do exercises, dedicating at least 30 minutes to it. Aerobic training (in the form of swimming or walking) is recommended. Proper control of your body and good posture should become a habit.
Examples of treatment of stenosis at the A.N. Center for Pathology and Neurosurgery Baklanova
Treatment
Surgical treatment
For patients who have increasing weakness, pain, or gait disturbance, surgery may be recommended. Options for stenosis at several levels may be as follows:
Anterior access:
— anterior cervical discectomy with spinal fusion; — anterior cervical corpectomy with spinal fusion; - their combinations.
The disc or bone that is compressing the spinal cord is removed from an anterior approach, and then the spine is stabilized. It involves the use of an implant, which is installed between two adjacent segments to support and compensate for the defect.
Rear access:
- laminectomy without stabilization (removal of a section of bone or ligament); — laminoplasty.
The posterior approach can be accomplished in two ways: direct removal of the offending structures and indirect dislocation of the spinal cord. The choice between the two operations depends on the location of the spinal cord compression, the number of levels of compression, posture, the presence of instability, neck pain, and risk factors for pseudarthrosis formation.
Laminoplasty is more effective than laminectomy without fusion because it reduces the risk of developing perineural adhesion and postoperative kyphosis. Surgeries from the anterior approach and laminectomy with spinal fusion are also less effective than laminoplasty. Laminoplasty protects segments during movement and prevents the development of complications such as implant displacement, the formation of a false joint and damage to adjacent segments.
After the operation, the patient remains in the hospital for several more days. In order for a person to quickly return to an active life, various rehabilitation programs are implemented. For example, a set of therapeutic measures may include exercises aimed at increasing the range of motion in the cervical spine.
Physical therapy
Conservative treatment aims to reduce pain intensity and increase function. It does not change the size of the spinal canal, but can provide long-term pain relief and improved function without surgery. The rehabilitation program may require 3 or more months of treatment under the supervision of a specialist.
The program may include:
- Stretching exercises: These exercises are aimed at restoring the elasticity of the muscles of the neck, torso, arms and legs. — Manual therapy: manipulation of the cervical and thoracic spine to improve and maintain mobility. — Heat therapy: microcirculation in muscles and soft tissues improves. - Cardio Exercise: It also improves blood circulation and increases the patient's cardiovascular endurance, ensuring good physical fitness. — Hydrokinesitherapy: it will allow your body to move without putting stress on the spine. – Training to increase daily physical activity and functional movements.
Exercises and techniques that can reduce symptoms of stenosis and prevent progression of the disease:
— Specific exercises to strengthen the muscles of the arms, torso and legs. - Stretch marks. — Exercises to correct posture. — Exercises to stabilize the scapula. — Recommendations for ergonomics to avoid harmful positions. — Planning your daily routine: you take breaks during daily activities such as walking or working in your garden. — Recommendations regarding “how to lift, push and pull correctly.”
Colleagues, we remind you that this weekend a seminar by Georgy Temichev “Neck pain and headaches” will be held in Moscow.
Source
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