Mayo Clinic Q and A: Treating cervical spinal stenosis - Mayo Clinic News Network (2024)

DEAR MAYO CLINIC: I was diagnosed with cervical spinal stenosis after several months of neck pain, along with weakness, numbness and tingling in one arm and hand that kept getting worse. My health care provider recommends surgery, including spinal decompression and fusion. Is there a less-invasive treatment I could try before surgery?

ANSWER: Although it is possible that nonsurgical treatment may be reasonable for you, it sounds likely that surgery is in your best interest. That decision should be based on several factors, though, including the severity of your symptoms and whether the condition is affecting your spinal cord function.

Spinal stenosis happens when the main channel for the spinal cord — called the central spinal canal — or the openings for individual nerve roots in your spine become narrowed, causing pressure on nerve tissue. Spinal stenosis often is a result of aging and the formation of bone spurs from arthritis. Many people also are born with a narrow spinal canal, making them more prone to stenosis as they age.

Whenspinal stenosis affects the spine in your neck, called the cervical spine, it canaffect a single arm (as in your case) if an isolated nerve root is compressed,or it may affect the entire body if the spinal cord is involved. The spinalcord is a vital structure because all the movement-related messages your brainsends to your body, as well as all the sensory messages your body generatesbelow your neck, travel through the cervical spinal cord.

Cervical spinal stenosis often triggers pain; weakness;numbness; or clumsiness in a hand, foot, arm or leg. It also can cause problemswith walking and balance. If left untreated, these symptoms may worsen, andadditional symptoms, such as bowel or bladder problems, may develop.

When spinal stenosis is suspected, a detailed medical historyand physical exam are necessary to find the cause of the symptoms. Imaging withMRI typically is performed to confirm the diagnosis and localize the stenosis.X-rays and CT scans usually are part of the evaluation, too, especially whenthere is significant neck pain, a spinal deformity or history of trauma. Anelectromyogram and blood tests also may be needed to confirm that symptoms area result of spinal stenosis.

Spinal stenosis treatments that don’t involve surgery includeself-care measures, medication, physical therapy and steroid injections. These treatmentsoften can relieve symptoms of mild spinal stenosis. But for individuals likeyou who have complaints that grow steadily worse, surgery may be necessary to preventpermanent spinal cord or nerve root damage, and relieve — or at least stabilize— symptoms.

When surgery is necessary, the goal is to create more space for the nerve tissue. During spinal decompression, a surgeon removes the bone, ligament or disc that’s putting pressure on the spinal cord or nerve roots. Spinal fusion is performed if the spine is deformed or unstable, or if the spine’s alignment and stability are compromised by decompression.

Spinal fusion involves reinforcing the spineby linking two or more of the vertebrae together with a bone graft. Metalimplants are used to maintain proper alignment and aid bone fusion. Spinalfusion is needed more often when stenosis surgery is performed in the cervicalspine because that area tends to become unstable as a result of spinaldecompression.

In some cases, an artificial disc can beinserted instead of performing a fusion to allow the vertebrae to continue tomove normally. But that approach is only appropriate for people who have awell-aligned spine without instability or significant arthritis. Occasionally,the cervical spine can be decompressed without fusion, especially when openingit from the back instead of the front.

Surgery for spinal stenosis usually is not a matter of urgency, so take time to discuss your concerns with your health care provider. Together, you can review the goals, risks and benefits of surgery, and decide what’s best for you. Results of surgery for spinal stenosis generally are excellent when the operation is performed for the right indications and the correct procedure is chosen. — Dr. Bradford Currier, Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota

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