Narrowing of the spinal canal in the neck (cervical spinal stenosis) is the narrowing of the spinal canal located just behind the neck vertebrae all around, compressing the spinal cord passing through it from top to bottom at various levels and accompanying pressure on the nerve roots. The canal can be structurally narrow, or it can be seen as a part of the normal aging process or due to acquired wear and degeneration. Along with this narrowing, there may be distortion of the shape of the neck, forward and backward sliding or rotation of the neck vertebrae. Contraction; It can be caused by degeneration of bones and thickening of the joints at the back of the spine, calcification of the ligaments in front and behind the canal, and degeneration and herniation of the soft cartilage discs between the vertebrae. In these patients, weakness, tingling, numbness in the arms and/or hands, weakness in the legs, loss of function and gait disturbance may be seen in more severe cases.
Cervical stenosis disease usually presents with complaints related to nerve root (radiculopathy) and spinal cord compression (myelopathy). While there is pain and numbness in the arms due to radiculopathy, the symptoms related to myelopathy, which are seen in more severe cases, are pain and numbness in the legs, increased reflexes in the arms and legs, clumsy and unbalanced walking, not being able to button up the shirt, tie the shoes, have difficulty in opening and closing the door handles, and not being able to open the lids of jars. manifests itself as fine skill losses. When these findings start to appear, if the diagnosis of cervical spinal stenosis is also made, surgery should be planned without delay. In the chronic process of the myelopathy stage, that is, in advanced cases where the disease also affects the legs, patients may not be able to walk unaided or may have spastic gait, incontinence of urine and stool. Surgery during this period cannot reverse the neurological loss, but prevents it from getting worse.
First of all, the complaints of the patient with suspected stenosis disease in the neck are questioned by the neurosurgeon. A detailed physical and neurological examination is then performed. Evaluation of arm and leg strength, balance-gait status and reflexes is very valuable in the preliminary diagnosis. Then imaging methods are applied. X-ray films, magnetic resonance imaging (MRI), computed tomography, electromyography (EMG), somatosensory evoked potentials are diagnostic methods used in the diagnosis of this disease. The gold standard diagnostic method is the examination of this region with MRI. MR imaging is an indispensable diagnostic tool to evaluate the disc structures in the distance between the vertebrae, the facet joints where the vertebrae articulate with each other, and the ligament structures that hold the vertebrae together, the spinal cord and the condition of the nerve roots emerging from the spinal cord. The appearance of spinal cord damage (myelopathy) seen in this examination can be considered as a sign that the disease is quite advanced. Other examinations are mostly requested in the differential diagnosis, as a complement or to assist during surgery.
Non-surgical methods are the first choice in the treatment of cases with radiologically detected narrow canal but not causing any complaints or findings, and in cases with mild cervical stenosis diagnosed after the evaluation of the specialist doctor. Damage caused by compression (myelopathy) in the spinal cord due to canal stenosis is one of the most important factors in making the decision for surgery. If there is no myelopathy, if weakness and loss of sensation in the arms, hands and legs are not advanced, non-surgical methods (such as physical therapy, drug therapy) may help partially solve the patient’s problem. The aim of surgical treatment is to remove the pressure on the spinal cord and nerve root, and to fix it if there is a mechanical disorder in the spine. This goal can be achieved with different surgical techniques. Surgeries are performed from the front or back of the neck. However, sometimes patients with severe and long segment stenosis may rarely require both anterior and posterior surgery. In operations performed from the front of the neck, it is determined where the spinal cord compression is from. If neck hernia, vertebral body and anterior ligaments cause compression of the spinal cord, the necessary intervention is done from the front of the neck. In surgeries performed in front of the spinal cord, parts that cause discomfort are removed. If the surgeon deems it necessary, he can insert a plate and screw system to strengthen the spinal cord. There are two types of surgeries performed on the back of the neck. One is laminectomy and the other is laminoplasty. In laminectomy, the lamina and ligaments that cause compression of the spinal cord from the back are removed. In laminoplasty, on the other hand, the cervical canal located behind the neck is widened by removing the lamina at problematic levels unilaterally and reassembling it with laminoplasty plates and screws.
