Spinal canal narrowing is the compression of the spinal cord passing through it by narrowing all around the spinal canal located just behind the vertebrae and the pressure it exerts on the nerve roots; this is how the signs of compression on the spinal cord are revealed, this is called “spondylotic myelopathy”. Weakness, tingling, numbness in the arms and/or hands in these patients; In more severe cases, weakness in the legs, loss of function and gait disturbance may occur. If spinal cord compression is advanced, symptoms such as difficulty or inability to do fine work (such as not being able to button a shirt or tie a shoelace) may occur in patients. In more advanced cases, where the disease also affects the legs, patients may not be able to walk unaided, and become unable to hold their urine and stool due to the contractions in their legs. Worsening in attacks is more common in these patients. The patient has comfortable or very few symptoms in the interim periods of these attacks. Very slow progression is seen in 25% of patients, and sudden worsening in 2% of patients.
If the cervical narrow canal is compressing the spinal cord and nerve roots, the pressure should be removed with surgery. Chronic compression, especially on the spinal cord, can lead to irreversible changes in the spinal cord. Therefore, the appearance of symptoms such as a feeling of stiffness in the legs, loss of strength and the gradual increase of these problems require immediate medical attention. Such a condition can be progressive and surgery is recommended to remove the pressure on the spinal cord to stop the progression. The surgery site may change depending on the place where the pressure is highest and the position of the neck. The important thing in cervical spondylotic myelopathy is to remove the pressure before permanent changes occur in the spinal cord.
On examination, patients may have increased reflexes in the arms and legs, and loss of strength and sensation in the hands and legs. In addition, a group of abnormal findings, which we call pathological reflexes, may be detected in the hands and feet. Direct radiographs of the neck vertebrae, computed tomography (CT) or 3-dimensional reconstruction computed tomography and magnetic resonance (MR) imaging are requested. Electrophysiological examinations, on the other hand, are abbreviated EMG, SSEP and MEP.
Non-operative methods (such as physical therapy, drug therapy) can help partially solve the patient’s problem; Surgery is performed if there is damage caused by compression due to canal narrowing in the spinal cord, which we call myelopathy, or if there is weakness and loss of sensation in the arms, hands and legs. The basis of the operation is the removal of the factors that cause pressure on the spinal cord, and this is called decompression surgery in short. Removal of this pressure is possible with operations to be performed from the front or the back, but the decision of which is more appropriate is made by the neurosurgeon.
If only cervical disc herniation causes pressure in anterior operations, only disc-oriented surgery can be performed. Sometimes, in the case of calcification, the spine body(s) and disc tissue are removed together along the affected levels. Bone or a lattice-like material that will replace bone is placed in its place, and fixation (fusion) is performed with plates and screws.
In operations performed from the back, it may be necessary to completely remove the structures forming the back of the spine. In this case, it would be appropriate to perform fixation (fusion) surgery by placing screws and rods holding them on the spine in order to strengthen the spine. It is also possible to widen the narrow canal condition with “laminoplasty” surgery, which is based on the removal of a part of the bones at the back of the spine and then placing them back in place with the help of screws and plates
