Cervical Stenosis

Cervical stenosis refers to a narrowing of the spinal canal in the neck, usually due to degenerative arthritis of the spine joints or bulging from a disc in between two vertebrae. Symptoms occur when the narrowing is severe enough to exert pressure on the spinal cord, the nerve roots, or both.

Pressure on the spinal cord causes myelopathy, which a patient may experience as numbness/tingling or a loss of dexterity in the hands, neck pain, and trouble with gait or balance. Physical examination signs of myelopathy include muscle weakness or atrophy, loss of sensation, and exaggerated reflex responses.

Pressure on the nerve roots from cervical stenosis causes radiculopathy, in which a patient may experience shooting pain from the neck down into the arm. There may be muscle weakness, sensory loss, neck pain, or a tingling sensation in the affected parts of the arm, too.

Cervical stenosis is a degenerative condition, meaning that medications and physical therapy have limited roles in reversing it. Surgery is the mainstay of treatment for patients with severe symptoms, and there are surgical options from both the front and the back of the neck (i.e. "anterior" and "posterior").

Anterior options for surgery include anterior cervical discectomy and fusion (ACDF) and cervical disc replacement (arthroplasty). Posterior approaches include cervical laminectomy with or without fusion and laminoplasty. Each of these options has benefits and drawbacks. The right option for you will depend on your symptoms, the number of spinal levels affected, and factors related to your medical history, age, and spinal anatomy.

Lumbar Stenosis

Lumbar stenosis refers to a narrowing of the spinal canal in the lower part of the back. The most common causes are degenerative arthritis of the spine joints, a herniated intervertebral disc, and slippage of one vertebrae on another (spondylolisthesis). Narrowing of the spinal canal exerts pressure on the nerve roots that travel down and supply strength and sensation to the legs.

Lumbar stenosis classically causes pain that radiates down one or both legs, often beginning in the buttock. There may also be muscle weakness, numbness, or tingling in the affected leg. Symptoms may be brought on by activity or walking, and some patients find relief by bending forward or lying down. Severely affected patients can have bowel or bladder dysfunction, including incontinence. Certain causes of lumbar stenosis, notably spondylolisthesis, may also cause back pain.

As with cervical stenosis, treatment is focused on removing pressure from the affected nerve roots. This can be accomplished directly by performing a laminectomy and/or indirectly by changing the alignment and spacing of the vertebrae with a lumbar fusion.

A spinal fusion should be considered when there is evidence of abnormal movements of the vertebrae ("instability"). There is an alphabet soup of techniques for fusing the lumbar spine: ALIF, OLIF, TLIF, PSF, and so on. Fundamentally, a fusion involves inserting metal hardware and bone graft to limit motion of a segment of the spine. Once the affected segment is immobilized, the goal is for your spine bones to grow across it, stabilizing it permanently. If a fusion is needed, I will review with you possible techniques along with their benefits and drawbacks.