What Is Cervical Spinal Stenosis Surgery?

The concept of cervical spinal stenosis is as the name implies, the diameter of the cervical spinal canal in all directions decreases, or the volume decreases. Cervical spinal stenosis can reduce the effective space and blood supply of the spinal cord and nerves, causing dysfunction. Therefore, cervical spinal stenosis is a general term for various diseases that cause spinal cord compression due to spinal stenosis, not a single specific disease.

Basic Information

Visiting department: orthopedics
Common locations: Cervical spine
Common causes: Herniated cervical disc, herniated disc, tumor, fracture and dislocation, post-operative, spondylolisthesis, Paget disease, osteopenia, ossification of the ligamentum flavum, etc.

Common symptoms: Numbness, irritation, or pain in the limbs, weakness, stiffness, and paralysis of the limbs; weakness in early urination, frequent urination, urgency, and constipation; late urinary retention, incontinence

Causes of cervical spinal stenosis

Narrow cervical spinal stenosis, the so-called primary spinal stenosis, is caused by both congenital and developmental factors. Generalized cervical spinal stenosis includes acquired factors, namely acquired cervical spinal stenosis, and there are different pathological types, such as herniated cervical disc (soft protrusion), disc herniation (hard protrusion) caused by simple degeneration, tumors, fractures, and Dislocation, postoperative operation, spondylolisthesis, Paget disease, osteopenia, ossification of the ligamentum flavum, ossification of the posterior longitudinal ligament, etc. The reader can learn about various cervical spinal stenosis in the various patient entries mentioned above.

The relationship between various related terms of cervical spinal stenosis

Some books introduce cervical spinal stenosis and cervical spondylosis as two independent diseases with their own pathological characteristics, but most textbooks do not have a chapter on cervical spinal stenosis. Only the chapter on cervical spondylosis has a relationship between developmental spinal stenosis and cervical spondylosis. set forth. Most scholars regard developmental spinal stenosis as a prerequisite for cervical spondylosis, that is, congenital and developmental spinal stenosis merely reduce the threshold of symptoms and signs of cervical spondylosis. In the literature, the concept of cervical spinal stenosis and cervical spondylosis is also inconsistent. According to the etiology, cervical spinal stenosis is often divided into four categories: developmental cervical spinal stenosis; degenerative cervical spinal stenosis; iatrogenic cervical spinal stenosis; secondary cervical spinal stenosis caused by other lesions and trauma. Therefore, cervical spinal canal stenosis should be regarded as a collective term that includes different pathological changes that cause neural channel stenosis, and textbooks discuss them separately, such as cervical spondylosis, cervical disc herniation, posterior longitudinal ligament ossification, trauma, and even Cervical spinal stenosis caused by cervical tuberculosis and tumors. Therefore, the generalized cervical spinal stenosis includes all pathological changes that cause the spinal canal diameter to become smaller, including cervical spondylosis. As described in the entry for spinal cord cervical spondylosis, it belongs to spinal cord compression, and its clinical manifestations and diagnosis are consistent. The treatment method should be determined according to the specific pathological type.

Clinical manifestations of cervical spinal stenosis

Cervical spinal stenosis is mainly manifested by limb numbness, allergies or pain. Most patients with cervical spinal stenosis have the above symptoms and are the first symptoms. Dyskinesia appears mostly after sensory disturbances, manifested as vertebral tract signs, weakness of limbs, stiffness and inflexibility. Most of them begin with weakness in the lower limbs, heavy, feet feel like stepping on a cotton, and those with heavy feet stand unstable and walk easily, kneeling, need to lean on a wall or double crutches, and quadriplegia appears as the symptoms gradually increase. Urinary dysfunction usually occurs late. In the early stage, there is weakness in urination, frequent urination, urgency, and constipation. In the later stage, urinary retention and incontinence can occur.

Cervical spinal stenosis examination

1. X-ray plain film inspection

Cervical spinal stenosis is mainly manifested by a decrease in sagittal diameter of the cervical spinal canal. Therefore, the measurement of the sagittal diameter of the spinal canal in a standard lateral radiograph is an accurate and simple method to establish a diagnosis.

2.CT scan check

CT can clearly show the cervical spinal canal morphology and stenosis. Bone spinal canal can be clearly displayed, but it is not good for soft spinal canal. CTM (CT plus myelography) can clearly show the interrelationship of osseous spinal canal, dural sac and lesions, and measure the area of various tissues and structures in the cross section of cervical spinal canal and the ratio between them.

3.MRI examination

MRI can accurately show the location and degree of cervical spinal canal stenosis, and can directly show the compression of the dural sac and spinal cord, especially when the spinal canal is severely narrowed and the subarachnoid space is completely obstructed. Side position. However, MRI does not show the normal and pathological osseous structure of the spinal canal as CT, because the cortex, fibrous ring, ligament, and dura mater are all low or no signal, and osteophytes, ligament calcification or ossification are also low or no Signal, therefore, is not as good as conventional radiographs and CT scans in showing spinal canal degenerative disease and the relationship between spinal cord and nerve roots.

4. Myelography

As a diagnosis of spinal canal lesions and spinal canal morphological changes and their correlation with the spinal cord. Early detection of spinal canal lesions can be performed to determine the location, extent, and size of the lesion. Multiple lesions are found, and qualitative diagnosis can still be made for certain diseases.

Diagnosis of cervical spinal stenosis

The diagnosis can be confirmed based on medical history, clinical symptoms and laboratory test data.

1. X-ray diagnosis

Spinal canal diameter is generally considered to be normal above 14mm, relatively narrow from 12 to 14mm, and absolute stenosis below 12mm. However, the measurement of the x-ray film is only a judgment of the size of the bony spinal canal. Factors such as hypertrophy of the ligamentum flavum and cervical instability must also be considered. In addition to the anterior and posterior diameter of the spinal canal, the distance between the anterior margin of the spinous process and the posterior margin of the intervertebral joint is less than 1 mm, which also indicates cervical stenosis. Lintner et al. Considered that the canal-body ratio (CBR) of the anteroposterior diameter of the spinal canal to the anterior-posterior diameter of the vertebral body (CBR) <0.8 to 0.9 indicates spinal stenosis.
2. MRI diagnosis On MRI, you can see that the T2 is thinner or disappears before and after the upper spinal cord. The spinal cord is flattened, and the relative volume of the spinal cord in the spinal canal is increased.

Cervical spinal stenosis treatment

For light cases, physical therapy, braking and symptomatic treatment can be used. Most patients with non-surgical treatment often have relief of symptoms. Spinal cord injury develops rapidly and severe symptoms should be treated as soon as possible. According to different approaches, the surgical methods can be divided into: anterior surgery, anterolateral surgery, and posterior surgery. The choice of surgical approach should be based on the clinical use of modern imaging techniques such as CT and MRI. Before the operation, the spinal canal stenosis and cervical spinal cord compression site should be identified, where the pressure is reduced, and the decompression of the compression segment is the principle. For those who have pressure in front and back of the spinal canal, anterior surgery should be performed first, which can effectively remove the direct or main pressure in front of the spinal cord, and bone graft fusion to stabilize the cervical spine to achieve therapeutic effects. If it is ineffective or the symptoms are not obvious, posterior decompression surgery should be performed after 3 to 6 months. Anterior and posterior approaches each have their own indications. The two cannot be replaced with each other and should be selected reasonably.