CERVICAL SPINAL STENOSIS
Definition and cause
Cervical spinal stenosis corresponds to a gradual narrowing of the canal through which the spinal cord passes, at the neck. This narrowing, or stenosis, is the result of disc wear (discopathy), often multiple herniated discs, and osteoarthritis of the spine. The tissue and ligaments will collapse, then bulge into the canal; joints between the vertebrae will deform and widen (osteophyte or parrot beak).
Course of the disease
The spinal cord will adapt to this narrowing during the first period of this condition, which can remain totally silent for years. First, the cerebrospinal fluid, in which the spinal cord is bathed, disappears at the level of the compressed areas. Then, the involvement of the spinal cord ((myelopathy) will be manifested by loss of strength or sensitivity in the limbs (arms or legs). Pain is not always associated. In the last stage, or when trauma is associated with it, complete paralysis may occur.
There is currently no treatment to prevent disc degeneration or the onset of osteoarthritis of the spine, or even to slow down their progress; therefore, there is no treatment to be implemented until the person is suffering from cervical spinal stenosis. However, the discovery of such an abnormality must receive the opinion of a spinal surgeon, to assess the risks and organize a follow-up. In case of sudden onset of numbness or muscle weakness, the surgical opinion must be requested urgently. If simple pain occurs, medical treatment can be implemented. It will combine analgesic and anti-inflammatory drugs, and sometimes massages or infiltrations. The aim of this treatment is to calm the inflammation around the compressed nerve roots and to achieve a possible resolution of the episode. However, the general trend is toward progressive worsening, often over several years. Based on the course of the disease, the physician and the patient will get an idea about the effectiveness of this treatment and seek a surgical opinion if it is not effective.
Principle of surgical treatment
If progress is not good, the surgeon, based on the severity of the patient’s symptoms, the duration of the disease, and the severity of the cervical spinal stenosis, will decide whether or not surgery is necessaryto decompress the spinal cord and the affected nerve roots. The type of surgery is determined on a case-by-case basis, and can be performed either through the front of the neck, for hernia removal and disc replacement, or through the back of the neck, to remove a portion of the back of the vertebra (laminectomy). Sometimes two successive procedures are required to achieve a complete release of the spinal cord.
Average hospitalization time
3 to 12 days, depending on whether one or two procedures are required (these are the durations most often reported).
A recovery period of at least 6 weeks following the surgery is essential. Based on the severity of symptoms before the procedure and the type of surgery performed, this period may be longer. Wearing a neck brace or a back brace may be necessary for 4 to 12 weeks. Recovery is not synonymous with bed rest. Physical exertion, carrying loads, and car trips must be limited during this period. Walking is often beneficial. Recurrence of pain during recovery is often the result of too much activity and will tend to disappear with rest.