A narrow canal in the neck (cervical spinal stenosis) is defined as the narrowing of the openings called foramen through which the spinal cord or the nerve roots, which are located in the neck vertebrae, pass. Degenerative changes caused by aging in the spine, deformed large hernias, bone extensions due to calcification, and rheumatic changes may cause the narrowing of the canal in which the spinal cord is located. This narrowing may give out signs by exerting pressure on the nerve roots or the spinal cord.
Stiffness of the neck, pain, difficulty in the use of hands, weakness or numbness in the hands, arms or legs, contractions in the legs, bladder or bowel dysfunctions may be encountered.
The disease usually begins with numbness and clumsiness in the hands accompanying neck pain. The patient’s clumsiness increases with time and skills such as opening the door with a key and buttoning are impaired. Gait disorder is added to this complaint over time. If the disease progresses too much, the patient will have a hemiplegic gait, will need help when walking, will not be able to work with his hands, and their urine and fecal control will be impaired.
The history of the disease is usually typical. The examination indicates the condition and severity of the disease. Magnetic resonance imaging (MRI), which is one of the modern diagnostic methods, can easily diagnose the narrow canal in the neck and determine its severity. With MRI, spinal cord damage can be seen as a white spot. SEP (Sensory evoked potential) and MEP (Motor evoked potential) are useful in demonstrating the conduction function of the spinal cord and are required in some cases. Computed tomography (CT) is very good in demonstrating the structure of the neck vertebrae. However, the most important criteria in diagnosing the cervical spinal stenosis are clinical examination, radiological findings of the physician and a combination thereof.
Medical treatment consists of drug use, bed rest, physical therapy and algological approaches. Muscle relaxants, painkillers, and anti-inflammatory drugs are used as medication. In addition, hot or cold compress application, and the use of a neck brace that prevents neck movements have great benefits in the elimination of muscle spasms. In case of illness, physical activities, especially forward and backward bending movements, should be performed slowly and in a controlled manner.
Surgical treatment should be performed when the patient does not respond to medication or if the spinal cord and nerve compression is severe. Surgical treatment can be performed by approaching the anterior or posterior part of the neck. The choice is up to the surgeon’s assessment. In kyphotic necks with high anterior pressure, it may be appropriate to approach from the front, i.e. the anterior. After removing the neck hernia in the required levels, the spine stems may also be removed. Sometimes lordotic patients with spinal cord and nerve compression from the back can be approached from the back of the neck to relieve the spinal cord and nerves. In these surgeries, plate screws and cages can be placed on the spine.
