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Cervical spinal stenosis is a narrowing of the spinal canal, which arises most frequently from wear-and-tear, poor posture, aging, and arthritis. Over time, the discs that cushion the vertebra lose their shock absorption abilities, and the bones that make up the spine lose their flexibility. Sometimes this degeneration also leads to bone spurs that compress the nerve roots. While conservative measures may help reduce pain, surgery may become necessary if the cervical stenosis progresses. Cervical spinal stenosis surgery encompasses several different procedures that aim to reduce pressure on the spinal cord and nerve roots. The surgery can help alleviate problems that arise from such pressure, including weakness, numbness, and pain.
People who experience neck pain, numbness in the hands, unsteadiness, or lack of coordination may be referred to a neurosurgeon for evaluation and possible diagnosis of cervical spinal stenosis. Diagnostic tools may include magnetic resonance imaging, computed tomography scans (CT scans), nerve conduction studies, x-rays, and myelograms. Based on the diagnosis, the doctor may first recommend conservative measures, such as physical therapy, reduction of activity, anti-inflammatory medication, and corticosteroid injections. If conservative therapy is inadequate, surgery may be recommended.
There are four types of cervical spinal stenosis surgery: discectomy, corpectomy, microdiscectomy, and laminectomy. A fifth procedure, called a spinal fusion, is sometimes used in conjunction with several of these surgeries. For a small group of patients, a spinal fusion may be performed as a standalone operation to correct spinal instability and help alleviate pain.
A discectomy is performed from the front of the neck and reduces pressure on the nerve roots by removing one or more discs and any bone spurs. The space between the vertebra may be filled with bone grafts, screws, and sometimes a metal plate, which will eventually fuse together and stabilize the cervical spine. A corpectomy, which is often required for multi-level stenosis, involves the removal of one or more vertebra as well as the discs. It is also done from the front of the neck, and the space left after vertebra removal is stabilized through spinal fusion.
A microdiscectomy, sometimes called a facetectomy, is performed through the back of the neck. This procedure may be used in such cases as a large disc herniation located at the side of the spinal cord. The facet joints are the links that connect one vertebrae to the next — this procedure removes part of the facet joint and any bone spurs. By moving the nerve root gently to the side, the pressure caused by the disc herniation can be reduced. In this procedure, spinal fusion is not normally required and recovery time is usually shorter — but the problem may recur, as the disc may herniate again.
A laminectomy is performed through the back of the neck and removes part of the lamina bone, located at the back of the vertebrae, as well as any bone spurs or disc fragments. A related procedure, laminotomy, can sometimes be performed via endoscopy.
Each of the procedures described has its advantages and disadvantages, and a prospective patient should discuss these with his or her surgeon. Like all operations, cervical spinal stenosis surgery carries its own risks and complications, which, while rare, should also be discussed with the surgeon and carefully weighed against potential benefits.
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