Cervical spinal stenosis, treatment, surgery, types

16 June 2020

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3.9 out of 5

Stenosis is a pathological narrowing of the spinal canal, in which compression of the spinal cord and the nerve roots extending from it is observed by various pathological formations. This condition is regarded as a serious complication of a number of spinal diseases, since it can lead to severe complications and ultimately disability. It is accompanied by constant pain in the affected area, paresis and paralysis.

Since the cervical spine bears a high load, it is its vertebrae and intervertebral discs that very often suffer from various degenerative processes. This explains that cervical spinal stenosis occurs in approximately a quarter of all cases of this disease.

What is cervical spinal stenosis

The spinal canal is a cavity inside the spine formed by the vertebral arches. On one side, it is reliably protected by the arch with the transverse and spinous processes, as well as the yellow ligament. On the other hand, it is protected by the vertebral bodies with cartilaginous layers (intervertebral discs) running between them and the posterior longitudinal ligament running along the entire length of the spine.

The spinal canal contains:

the spinal cord, additionally protected by the dura, arachnoid and soft membranes;
spinal roots, through which nerve impulses are transmitted to all internal organs, muscles, skin;
blood vessels.

Its narrowing is observed when the vertebrae or discs of the cervical spine are deformed, as well as the formation of neoplasms of various nature, as a result of which they begin to protrude into the spinal canal and mechanically compress the anatomical structures located in it. In such cases, radicular syndrome initially most often develops with all the ensuing consequences in the form of impaired sensitivity, hand mobility, persistent headaches, dizziness, etc.

If you do not intervene in the process at this stage, the existing pathology progresses and ultimately the size of the pathological protrusion can reach such a value that it will put pressure on the spinal membrane and, accordingly, the spinal cord and provoke an increase in the pressure of the cerebrospinal fluid (CSF). In such cases, the symptoms become much more pronounced, and if there is no intervention, the person may completely lose his ability to work and become deeply disabled.

Treatment: drugs, surgery and recommendations

Drug treatment of carotid artery stenosis can be quite effective, but only if the course is uncomplicated and there are no other diseases.

Drugs

Depending on the degree of narrowing, the following drugs may be included in the treatment regimen:

microcirculation correctors (“Actovegin”, “Trental”);

"Actovegin"

neuroprotective drugs (“Pantogam”);
vasodilators with antihistamine action (“Cinnarizine”);
statins for correcting cholesterol levels and cholesterol load (“Atorvastatin”).

"Atorvastatin"

Treatment also includes correction of the underlying disease, which causes narrowing of the blood vessels in the neck and head. For example, for osteochondrosis, drugs from the group of NSAIDs, chondroprotectors, and centrally acting muscle relaxants are additionally prescribed. If there are intervertebral hernias that compress the blood vessels of the cervical spine, they are reduced (surgically).

Ischemic stroke, cerebral hemorrhage

Clinical guidelines

To achieve and maintain positive dynamics, it is also important for the patient to follow the clinical recommendations of specialists on lifestyle and diet. It is necessary to exclude from the diet all foods containing large amounts of fats and carcinogens (smoked meats, lard, sausages, etc.), as well as alcoholic beverages and hot spices. About 30% of the daily food intake should be vegetables and fruits. This group also includes berries and greens: their consumption improves the viscosity and fluidity of the blood and enriches the diet with essential vitamins and minerals.

If the patient suffers from tobacco addiction, you should contact a specialist who will prescribe complex therapy and help cope with the addiction. At the same time, it is important to understand that the craving for smoking is very difficult to correct, so observation by a narcologist is not enough: in most cases, patients also need the help of a psychologist or psychotherapist.

You need to stop smoking

Obese people should control their body weight, as excess weight is one of the main factors in the development of atherosclerosis and other vascular pathologies.

Clinical recommendations for the treatment of vascular insufficiency caused by pathological narrowing of the neck vessels also include the following points:

control of psycho-emotional state;
providing adequate physical activity appropriate to age and level of fitness;
selection of anatomical sleeping accessories;
regular walks (necessary to prevent hypoxia).

Regular walks are very important

Experts also call therapeutic exercises as one of the main measures for complex treatment of stenosis. Sets of special exercises for the cervical spine help eliminate muscle spasms, increase the flow of blood and lymph in the vessels, improve metabolic processes in the intervertebral discs of the neck, reducing the risk of dystrophic changes and degeneration of neighboring vertebrae.

Gymnastics for the cervical spine

Surgery

One of the most effective and safe methods of treatment for narrowing of the vessels of the cervical spine is stenting. The essence of the operation is to install a special metal stent in the form of an elongated tubular plate, which expands the internal lumen of the affected artery and restores its capacity. The speed of recovery depends on the individual characteristics of the patient and is about 3-10 days. In some cases, the patient is discharged home the very next day with recommendations to follow a gentle regimen and to attend a follow-up appointment with a surgeon and neurologist after 10 days.

Types of cervical stenosis

Cervical stenosis can be:

congenital or primary, i.e. result from congenital structural anomalies;
degenerative or acquired, resulting from the progression of degenerative-dystrophic diseases of the spine;
combined or mixed, developing against the background of a combination of factors.

Depending on which part of the spinal canal decreases in size, there are:

lateral or lateral stenosis – the volume of space in the area of the spinal roots decreases;
central – the free space in the middle of the spinal canal decreases.

Reasons for the development of pathology

Cervical stenosis can result from a huge number of diseases of the spine of this region, in particular:

compression fracture of the spine;
inflammatory diseases, including spondylitis;
Bekhterev's disease;
arthrosis of the facet joints with an increase in their size;
formation of benign and malignant tumors, metastases;
intervertebral hernia;
deforming spondyloarthrosis;
spondylolisthesis;
spondylosis;
pathologies of the posterior yellow ligament, accompanied by its thickening and compaction.

Sometimes cervical stenosis is a consequence of the formation of adhesions after surgery on the cervical spine.

Prerequisites for the development of the disease are created in the presence of:

osteochondrosis;
overweight;
spinal curvatures.

In the vast majority of cases, cervical spinal stenosis occurs in people over 55 years of age.

Symptoms of cervical spinal stenosis

Narrowing of the spinal canal cannot be asymptomatic. This is a severe pathology, which is always accompanied by pain in the neck on one or both sides, as well as neurological disorders.

Initially, pain can only occur when moving the neck or when the head takes a certain position. But as the causes of stenosis progress, pain appears more and more often and quickly becomes a constant companion of a person. Over time, they begin to radiate to the back of the head, shoulders, shoulder blades and arms.

In addition to pain, cervical stenosis may be accompanied by the following symptoms:

headaches of varying intensity, up to migraines;
Sensitivity disorders of the scalp, arms, and neck;
feeling of numbness, crawling;
weakness of the muscles of the arms and shoulders;
dizziness, up to loss of consciousness due to infringement of the vertebral arteries and impaired blood supply to the brain (more often observed with a sharp tilt or turn of the head);
increased muscle tone, which is a reflex response of the body to pain, which leads to increased pain and disruption of the nutrition of muscle fibers due to compression of their blood vessels.

In more severe cases, stenosis can lead to disruption of the functioning of all organs and parts of the body located below the level of damage. In such situations, you may experience:

dysfunction of the pelvic organs (increased urge to urinate and defecate, urinary and fecal incontinence, erectile dysfunction, decreased libido);
paresis (sensitivity disturbances) of the lower extremities;
periodically occurring or constant feeling of “woolly legs”, gait disturbance, decreased stability, paralysis of the lower extremities;
disorders of the respiratory system, which can be accompanied not only by difficulty breathing, shortness of breath, increased frequency, but also attacks of suffocation.

Clinical types of the syndrome

Posterior cervical sympathetic syndrome (Barre–Lieu)

Posterior cervical syndrome is characterized by headaches localized in the cervical-occipital region with radiation to the front of the head. The headache is usually constant, often in the morning, especially after sleeping on an uncomfortable pillow. Headache may occur when walking, driving a car, or when moving the neck. The headache can also be pulsating, piercing, localized in the cervical-occipital region and radiating to the parietal frontal and temporal zones. Headache may intensify when turning the head and is accompanied by vestibular, visual and autonomic disorders.

Migraine basilar

Basilar migraine does not result from compression of the vertebral artery, but from stenosis of the vertebral artery, but clinically has much in common with other forms of vertebral artery syndrome. As a rule, a migraine attack begins with a sharp headache in the back of the head, vomiting, and sometimes loss of consciousness. Visual disturbances, dizziness, dysarthria, and ataxia are also possible.

Vestibulo-cochlear syndrome

Disturbances from the hearing system manifest themselves in the form of noise in the head, decreased perception of whispered speech and are recorded by changes in data during audiometry. Tinnitus is persistent and long-lasting and tends to change when the head moves. Cochlear disorders are associated with dizziness (both systemic and non-systemic).

Ophthalmic syndrome

With ophthalmic syndrome in the foreground, visual disturbances such as scintillating scotoma, decreased vision, photopsia may also be symptoms of conjunctivitis (lacrimation, conjunctival hyperemia). Loss of visual fields can be episodic and is mainly associated with changes in head position.

Autonomic change syndrome

As a rule, autonomic disorders do not appear in isolation, but are combined with one of the syndromes. Autonomic symptoms are usually the following: a feeling of heat, a feeling of cold extremities, sweating, changes in skin dermographism, sleep disturbances.

Transient ischemic attacks

Ischemic attacks can occur during the ischemic stage of vertebral artery syndrome. The most common symptoms of such attacks are: transient motor and sensory disturbances, visual disturbances, hemianopsia, ataxia, attacks of dizziness, nausea, vomiting, speech impairment, swallowing, double vision.

Syncopal vertebral syndrome (Unterharnscheit syndrome)

An episode of syncopal vertebral syndrome is an acute circulatory disorder in the area of the reticular formation of the brain. This episode is characterized by a short-term loss of consciousness when turning the head suddenly.

Drop attack episodes

An episode of a drop attack (fall) is caused by impaired blood circulation in the caudal parts of the brainstem and cerebellum and will clinically manifest itself as tetraplegia when the head is thrown back. Restoration of motor functions is quite rapid.

Complications of spinal canal stenosis

The main danger of primary stenosis is dysfunction of the respiratory system, which is observed against the background of compression of the spinal roots. Shallow breathing may be replaced by attacks of suffocation, which sometimes goes away on its own. But such situations are extremely dangerous for human life, so it is better not to take risks and immediately seek medical help.

Also, as a result of the narrowing of the canal, a change in the quality of nutrition of the spinal cord and brain is observed, since formations protruding into its lumen can compress the vertebral arteries, as well as other blood vessels. In such situations, surges in blood pressure may occur, which can lead to ischemic areas in the brain and stroke.

Other complications of such conditions include:

brain hypoxia;
massive swelling;
poor circulation throughout the body;
development of deviations in the functioning of internal organs;
changes in the tissues surrounding the spinal canal.

Such complications do not pose such a threat to life as respiratory failure or ischemia of brain tissue, but they can significantly reduce a person’s quality of life and ultimately lead to extremely severe and sometimes fatal consequences. Therefore, it is important not to neglect the existing symptoms of the disease, but to immediately consult a doctor in order to diagnose the causes of their occurrence and prescribe treatment appropriate to the situation.

Diagnosis of cervical stenosis

Diagnosis and treatment of cervical stenosis is the task of a neurologist or vertebrologist. It is these specialists that should be contacted if you have diseases included in the list of causes of stenosis, as well as if the above symptoms occur.

Initially, the specialist will conduct a thorough survey of the patient, find out the nature of the existing complaints, familiarize himself with his medical record and the results of previous examinations. This will allow him to understand what diseases are already present in a person, how they were treated and what effect was achieved. He will then examine the patient and perform a series of neurological tests that will help determine the presence of neurological deficits and the extent of damage to the spinal cord. Particular attention is paid to the position in which the patient feels best.

Based on these data, the doctor can assume the presence of stenosis and make a preliminary diagnosis. But it definitely requires confirmation using instrumental diagnostic methods. Therefore, patients are prescribed:

X-ray of the spine in two projections - allows you to detect bone growths called osteophytes, violations of the integrity of bone structures, their fusion, signs of tumor formation;
CT is a more modern method for diagnosing bone tissue disorders, allowing high accuracy to visualize the slightest deviations from the norm, their size, nature, location;
MRI is the most informative method for studying the condition of soft tissues, including cartilaginous structures, allowing a thorough assessment of the degree of stenosis, the presence of compression of the spinal roots and the causes of their occurrence;
Myelogram is an X-ray diagnostic method that involves the introduction of a contrast agent to determine pathologies of the spinal cord, assess the condition of the cerebrospinal fluid and the quality of its movement.

Patients are not always prescribed all of the above methods. Which ones will be carried out depends on the nature of the existing spinal pathologies and concomitant diseases, since almost every modern instrumental diagnostic method has certain contraindications for use. But in most cases, patients are prescribed MRI of the cervical spine, since this type of tomography provides the maximum amount of objective, highly accurate data.

Congenital vasoconstriction

Narrowing of the neck vessels can be a congenital pathology, which is rarely isolated and usually develops against the background of other diseases, for example, vascular hypoplasia, abnormal development of the cervical vertebrae, vertebral arthrosis. Of great importance in the prevention of congenital defects of the spine is the intake of folic acid (vitamin B9) during the period of preparation for pregnancy and in the first trimester, when the formation of all vital organs of the fetus, including the neural tube, occurs.

Folic acid during pregnancy

Not only deficiencies of various vitamins, but also other factors (from the mother’s side), for example:

infectious diseases of the mother, leading to infection of the amniotic fluid and amniotic membrane;
intoxication of the fetus with decay products of ethyl alcohol, nicotine, ammonia and other toxic substances (if the mother has bad habits or the woman lives in environmentally unfavorable areas);
injuries received during pregnancy.

Trauma during pregnancy

Deformation of the cervical vertebrae and the resulting narrowing of the neck vessels in a newborn may be the result of a protracted or difficult labor, especially if obstetric forceps or a vacuum aspirator were used to remove the baby.

Treatment of cervical stenosis

If, according to diagnostic results, the narrowing of the spinal canal is not accompanied by a high risk of developing dangerous conditions, patients are prescribed conservative treatment. It is always comprehensive and includes:

drug therapy;
physiotherapy;
Exercise therapy.

Unfortunately, conservative treatment gives positive results only in 32-45%. In all other cases, eliminating the risk of severe complications and loss of ability to work can only be achieved through surgical intervention.

Drug therapy

For each patient, the nature of drug treatment is selected individually, taking into account the causes of stenosis and the presence of concomitant diseases. In most cases, the list of prescribed medications includes:

NSAIDs are the most popular drugs with analgesic and anti-inflammatory properties. They are prescribed in different dosage forms (tablets, injection solutions, topical agents) based on the severity of the pain syndrome and the inflammatory process.
Corticosteroids are drugs with pronounced anti-inflammatory properties, which are most often injected directly into the area of stenosis. With their help, you can quickly eliminate swelling and inflammation, which not only helps reduce pain, but also has a positive effect on the quality of blood circulation in the affected area, as well as the transmission of nerve impulses.
Diuretics are medications with diuretic properties that eliminate swelling of soft tissues and normalize cerebrospinal fluid pressure.

This list may expand and include specific drugs aimed at eliminating the symptoms and causes of the development of a particular spinal disease.

Physiotherapy

For cervical stenosis, physiotherapeutic procedures are mandatory. They complement the effect of drug therapy, which together leads to an improvement in the patient’s condition.

Most often, a course of electrophoresis procedures with the administration of novocaine is prescribed. The essence of the method is to use electric current to ensure deep penetration of the drugs used into the body without violating the integrity of the skin. The procedure gives a good analgesic effect.

Magnetic therapy is also often used. This method is based on the positive effect of a magnetic field on the human body. With its help, it is possible to reduce the severity of swelling and also temporarily relieve pain.

Exercise therapy

Therapeutic exercise helps improve blood circulation in the neck, which helps reduce swelling and quickly remove metabolic products. Also, with the help of special exercises, you can normalize muscle tone and reduce pain. But which exercises will be useful for a particular patient is selected strictly individually, taking into account the diagnosis and individual characteristics.

The use of complexes distributed online is fraught with aggravation of the situation and a sharp deterioration in the condition. Often, careless movements or incorrectly chosen exercises provoke the need for emergency surgical intervention.

How is the diagnosis confirmed?

The main method for diagnosing narrowing of the carotid and basilar arteries is CT angiography. This method allows you to study a three-dimensional image of the blood vessels under study and evaluate the strength and characteristics of blood flow. Unlike conventional angiography, computed tomography eliminates the risk of complications from surgical interventions associated with the introduction of contrast (with CT angiography, the solution is injected into the femoral vein). Significant contraindications for this study are allergies to iodine and iodine-containing drugs, high obesity, pregnancy, severe forms of tachycardia or other heart diseases. The use of CT angiography is contraindicated in cases of decompensated diabetes mellitus, as well as acute renal or heart failure.

CT angiography

If there are such contraindications, CT angiography can be replaced by the following types of diagnostics (usually in combination):

Ultrasound of the vessels of the neck and head (using Doppler ultrasound);
magnetic resonance scanning;
determination of blood cholesterol levels and study of blood lipid balance;
instrumental examination of the arterial pulse (used quite rarely).

Ultrasound of neck vessels

An ECG is also used to identify provoking factors and assess the functioning of the heart muscle.