Cervical spinal stenosis is accompanied by myelopathy and/or radiculopathy. Most patients with cervical radiculopathy are initially treated with nonsurgical methods.
The first step in the treatment is “activity modifications”. They are generally simple measures such as adjusting the height of your computer or your chair. Pain medication and local ice or heat applications may also be recommended. Bed rest may be beneficial for a limited period of time. Long-term bed rest is often not recommended since it may negatively affect physical condition and fitness.
Prescribing anti-inflammatory drugs, muscle relaxants, or narcotic painkillers may be the next step when aforementioned precautions are ineffective in pain control. Physical therapy and rehabilitation program is an important part of the healing process and generally will start with also a light stretching and flexibility program as well as informing you about proper ergonomics at home and/or at work. As your pain decreases, mild strenthening exercises may be added to the program.
Epidural steroid injections that are cortisone injections made around the inflamed nerve may be recommended in some patients with cervical root disease. The purpose of the injection is to decrease the inflammation and relieve the pain.
In mild stenosis where the spinal cord is unaffected, nonsurgical treatment may be beneficial. The patients should be careful about avoiding conditions or injuries that may risk their spinal cords. Occupational physiotherapists can make suggestions on daily activities such as bathing, dressing, opening jars, or using keys. If the cervical myelopathy symptoms are evident or progressive, you need to be evaluated by a spine surgeon.
What are Surgical Options?
When nonsurgical methods are ineffective in relieving pain, surgery is an appropriate alternative. An operation pefomred from the front (anterior), back (posterior), or both may be recommended based on your symptoms. To make the decision on the treatment method, your surgeon will examine you to determine the compression sites in the spinal cord or the nerve roots, and the number of compressed levels. Radiographic and laboratory examinations will help in diagnosing the alignment of your cervical spine and general medical condition. Depending on the type of operation, you may need to wear a collar for a short period.
In the front approach, a small incision is made on the front side of your neck parallel to your skin wrinkles. The tissues will be pulled aside meticulously, and the cervical vertebra will be reached. The disc and tissues compressing the nerve root are removed. A cage is put in between the bones to replace the disc space and the two vertebrae are stabilized to each other with plates and screws. The anterior (front) surgery may be performed at more than one level; it may also require removal of discs and vertebrae.
In the back approach, the incision corresponds to where the nerve roots exit the spinal cord. Bone prominences compressing the nerve will be removed. Small disc fragments can be removed from this hole—either via laminectomy or laminoplasty. In laminectomy, the part at the back of the vertebra is completely removed. In laminoplasty, the lamina is elevated on a hinge to reach the space for the spinal cord, which is put back into place at the end of the operation. Sometimes metal screws and plates may be used for stabilizing the spinal column in the neck.