Narrowing of the spinal canal in the neck (cervical spinal stenosis) is the narrowing of the spinal canal located just behind the cervical vertebrae, compressing the spinal cord passing through it from top to bottom at various levels and causing pressure on the nerve roots. While the canal may be structurally narrow, it may also occur as a part of the normal aging process or due to acquired wear and degeneration. With this narrowing, there may be deterioration in the shape of the neck, shifting or rotation of the cervical vertebrae forward and backward. Contraction; It may be caused by degeneration in the 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 and numbness in the arms and/or hands, and in more serious cases, weakness in the legs, loss of function and gait disturbance may be observed.
Cervical stenosis is usually due to nerve root (radiculopathy) and spinal cord compression (myelopathy). It manifests itself with complaints. While radiculopathy causes pain and numbness, especially in the arms, in more severe cases, symptoms related to myelopathy include pain and numbness in the legs, increased reflexes in the arms and legs, clumsy and unbalanced walking, not being able to button up shirts, not being able to tie shoelaces, having difficulty opening and closing door handles, not being able to open jar lids. It manifests itself as loss of fine skills. If cervical spinal stenosis is diagnosed when these findings begin to appear, surgery should be planned without delay. In the chronic phase of myelopathy, that is, in advanced cases where the disease also affects the legs, patients may not be able to walk without assistance or may have a spastic gait and inability to hold urine and feces. Surgery to be performed during this period cannot reverse the neurological loss, but it can prevent it from getting worse.
The complaints of the patient with suspected neck stenosis are first questioned by the neurosurgeon. Then, a detailed physical and neurological examination is performed. Evaluation of arm and leg strength, balance-gait status and reflexes are very valuable in preliminary diagnosis. Then imaging methods are used. X-ray films, magnetic reso Nance imaging (MRI), computed tomography, electromyography (EMG), somatosensory evoked potentials are the diagnostic methods used to diagnose this disease. The gold standard diagnostic method is to examine this area with MRI. MRI imaging is an indispensable diagnostic tool to evaluate the disc structures located between the vertebrae, the facet joints where the vertebrae articulate with each other, the ligament structures that hold the vertebrae together, the spinal cord and the condition of the nerve roots exiting the spinal cord. The appearance of spinal cord damage (myelopathy) seen in this examination can be considered a sign that the disease is quite advanced. Other tests are mostly requested in the differential diagnosis, as a complement or to assist during surgery.
Cases with radiologically detected stenosis but not causing any complaints or symptoms and the evaluation of the specialist doctor In cases with mild cervical stenosis diagnosed later, non-surgical methods are the first option in treatment. Damage caused by compression (myelopathy) due to canal stenosis in the spinal cord is one of the most important factors in deciding on surgery. If there is no myelopathy, weakness and loss of sensation in the arms, hands and legs are not severe, non-surgical methods (such as physical therapy, drug therapy) may help to partially solve the patient's problem. The purpose of surgical treatment is to eliminate the pressure on the spinal cord and nerve root and to fix any 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 in patients with advanced and long-segment stenosis, surgery may be required from both the front and back sides. In surgeries performed from the front of the neck, the procedure is performed by determining where the spinal cord compression occurs. If a cervical disc herniation, the vertebral body and the ligaments in the front cause compression of the spinal cord, the necessary intervention is performed 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 called laminectomy and the other is laminoplasty. laminect In the OM procedure, the laminae and ligaments that cause compression of the spinal cord from behind are removed. Laminoplasty involves widening the cervical canal at the back of the neck by removing the lamina at problematic levels unilaterally and reattaching it with laminoplasty plates and screws.
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