Neck Nerve Canal Narrowing (Cervical Stenosis)

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Causes of Neck Canal Narrowing

Cervical stenosis refers to the thickening of the soft tissue, bone structure, disc and ligament located just behind it, around the canal through which the spinal cord passes, and the narrowing of the canal diameter and pressing on the spinal cord.

The developing stenosis may be asymptomatic unless structural changes such as thickening of the ligaments, age, trauma, arthrotic changes of the facets, and the development of spondylotic bars do not decrease below critical levels enough to compress the neural elements.

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Cervical Stenosis (Neck Nerve Canal Narrowing) Complaints

Although spinal stenosis (narrowing of the neck canal) often becomes symptomatic after the age of 70, it can occur at any age. It is more common in men.

  • Heaviness in the legs.
  • Difficulty walking
  • Difficulty in performing fine movements that require skill such as writing, pressing a button,
  • Feeling intermittent pain, especially when the head is bent forward, such as electric shocks in the hands and legs,
  • Arm pain,
  • Muscle wasting and discoloration in the hands and arms,
  • In advanced cases, deterioration in urinary and stool functions,
  • It causes complaints such as dizziness and imbalance.


Diagnosis of Neck Canal Narrowing

First of all, the findings of compression on the spinal cord should be investigated together with a good examination. In the examination, pathological reflexes and loss of strength are evaluated thoroughly and imaging methods are applied. These:

Radiography: In the diagnosis of stenosis, narrowing of the interpedincular distance with anteroposterior images and sagittal stenosis of the intervertebral canal can be observed with lateral images. In addition, osteophytes, degenerative spondylolisthesis, and hypertrophic facets can also be viewed as related conditions.

Myelography: Myelogram gives information about the amount of pressure applied on the nerve roots. Myelo-CT is still used as an important test in the diagnosis of stenosis.

CT: Anteroposterior tomograms are useful for illustrating the anatomical patterns of the laminas, inferior and superior facets, and pedicles. Wide, thick and short facets and thick and close to each other facets are the most common findings. The disadvantage of CT is that it is difficult to view the entire channel.

MRI: With this method, which is superior to myelography and CT, the entire spinal canal can be examined. Soft tissue changes such as disc extrusions and ligamentum flava hypertrophy can also be better visualized. However, bone details can be better visualized with CT.

Neck Nerve Canal Narrowing (Cervical Stenosis) Treatment

Treatment can be examined in two parts.
1. Non-Surgical Treatment
2. Surgical treatment

Non-Surgical Treatment:

If the stenosis that develops is moderate, most patients can be successfully treated without surgical intervention. Methods that do not require surgical intervention are postural changes, physical therapy programs including re-education of activities of daily living, stretching and stretching exercises. TENs units are particularly useful in acute pain attacks.

If the candidate is not suitable for surgery or the surgical procedure is delayed, epidural steroid administration is performed.

The most frequently used non-surgical method in cases with stenosis is drug therapy. It has been observed that nonsteroidal anti-inflammatory medication significantly reduces leg and back pain. Developing sleep disorders can be prevented with reduced doses of antidepressants.

Surgical treatment

  • Surgical intervention should only be considered in cases where there is an unsuccessful response from non-surgical treatment as a result of sufficient duration, dose and administration.
  • Indicated in severe stenosis where pain is intractable.
  • If bladder or bowel dysfunction is added, surgery should be the definitive procedure.
  • If the patient has the existing clinical picture of lumbar and cervical stenosis together, the cervical region should be decompressed first.
  • The patient should never be pressured about the decision to operate. It should be noted that a delay of months or even years in spinal stenosis surgery will not adversely affect surgical results, unlike disc surgery.

 

Surgical Techniques

Surgical intervention should only be considered in cases where there is an unsuccessful response from non-surgical treatment as a result of sufficient duration, dose and administration.

  • Indicated in severe stenosis where the pain is unbearable.
  • If bladder or bowel dysfunction is added, surgery should be the definitive procedure.
  • If the patient has the existing clinical picture of lumbar and cervical stenosis together, the cervical region should be decompressed first.
  • The patient should never be pressured about the decision to operate. If the patient has a single or 2 level stenosis and does not have any conditions such as slipping or bending in the neck, simple decompression surgery from the back of the neck will be sufficient.

There are series in which spondylolisthesis has been reported with rates of 2% to 0 developing instability after decompression in patients with two or more levels of stenosis. It should be noted that a delay of months or even years in spinal stenosis surgery will not adversely affect surgical results, unlike disc surgery. The results are worse if 2 mm or more listezis develops after decompression.

Listic complications are reported more frequently in female patients. In order to prevent these situations, screwing surgery is recommended together with decompression surgery performed at the back of the neck.

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