Cervical Stenosis Treatment in NJ

CERVICAL STENOSIS IS A condition that occurs when there is narrowing (i.e. stenosis) of the passages through which the spinal cord and nerves travel within the cervical (neck) spine. Typically, this narrowing results from an arthritic overgrowth, or spondylosis, of the bones, joints, and ligaments of the cervical spine. Stenosis develops slowly and is progressive. It is more common after 40 years of age.  If mild, it can be treated with physical therapy and steroid injections. If severe, it will require surgery to correct such as an Anterior Cervical Interbody Fusion  or disc replacement. At Centers for Neurosurgery, Spine, and Orthopedics, our New Jersey team includes world-renowned neurosurgeons, orthopedic spine surgeons, pain management doctors, and physical therapists who provide a comprehensive treatment plan for each patient.

Comparison of Rigid and Mobile Prosthetics in Spine

 

Symptoms of Cervical Stenosis

Symptoms of cervical stenosis can be caused either by narrowing of the central spinal canal in the neck (central stenosis) or by a narrowing of the passages where nerve roots exit the spinal canal called the foramina, traveling to the shoulders, arms, and hands. If this  region of the vertebra becomes stenosed, it is call foraminal stenosis.

Central cervical stenosis results in the compression of the spinal cord, which is the neural structure that acts as a conduit for signals between the brain and various body parts. When compressed, these signals do not get transmitted properly. Patients with central cervical stenosis usually present with symptoms of spinal cord irritation or dysfunction which includes loss of balance, arm or leg bilateral arm and leg weakness, loss of coordination and can lead to permanent paralysis or quadraplegia.

Foraminal cervical stenosis causes a pinched nerve at the level of the spine where it exits the spinal column on its way to the shoulders, arms, and hands. Commonly, foraminal stenosis causes symptoms of pain or tingling sensation shooting down one of the arms. Spasms of the neck and shoulder areas may also occur. Numbness, tingling, burning, and/or cramping sensations may also be felt in the arm, hands, or fingers. More severe cases may cause muscle weakness or loss of muscle tone.

Causes of Cervical Stenosis

Most cases of cervical stenosis build up over time, as a result of arthritic changes in the bones, joints, and ligaments that surround the spinal cord and spinal nerves. Eventually, these arthritic changes can cause a narrowing of either the spinal canal itself or around the passage (e.g. foramen) where the nerves leave the spine on their way to the shoulders, arms, and hands. Cervical stenosis is commonly seen in people ages 50 and older. Stenosis can be due to other reasons, such as spondylolisthesis, trauma, tumors or fractures, which may cause symptoms to occur in younger age groups.

Diagnosis of Cervical Stenosis

Through a detailed history,exam, and diagnostic imaging, your doctor can distinguish whether your symptoms are caused by cervical stenosis, or by an unrelated problem such as vitamin deficiency, stroke, or neurologic disorder such as ALS. The cause of symptoms can NEVER be diagnosed from an imaging study such as an MRI alone. The physical examination typically includes:

  • Range of motion test: Assessing how far you can move your spine in each direction and which movements cause pain or electrical sensations.
  • Neurological assessment: A group of tests that evaluates your neural network to localize where within the nervous system your symptoms are originating. This assessment includes testing:
    • Coordination and fine movements
    • Reflexes
    • Walking and balance
    • Sensation to light touch and pin prick
    • Individual muscle strength in the neck, arms, hands, back, core, legs, and feet
  • Palpation: Touching, pushing, and squeezing of muscles and other structures to determine alignment, muscle tone or atrophy, spasms, and to provoke sensations.

Depending on what your doctor finds on your exam he or she may make a diagnosis of cervical stenosis. If necessary, your doctor may order further testing to refine the diagnosis.

  • X-ray: An image of the bones in your spine. An x-ray can locate arthritic changes in the vertebrae, including the location and severity of bone spurs. Load bearing X-rays can also be used to assess abnormal bone alignment, which may contribute to your stenosis symptoms.
  • MRI (magnetic resonance imaging): An image of the soft tissues of the spine, which cannot be seen on an X-ray. Most commonly an MRI will be ordered for the physician to locate the exact level of neural compression involved in cervical stenosis. MRI can also locate tumors, damaged discs, and loose ligaments in the spine causing pressure on the spinal cord.
  • Cat Scan: To review in greater depth, and at various angles bony structures, and anatomy other than neuronal tissue or muscles such as blood vessels, and lungs.
  • Electromyography (EMG): An EMG measures the activity of the muscles at rest and during contraction, determining the communication of the nerve to the muscle. In an EMG test, needles are used in addition to electrodes. This study helps evaluate the extent of possible nerve damage involved in your cervical stenosis.

Treatment of Cervical Stenosis

Most patients improve with conservative treatments, such as structured physical therapy, using a combination of traction, core strengthening, skeletal stabilization, and postural training. These can be performed in combination with medications. With proper physical therapy, muscles around the cervical spine become stronger and help to stabilize the arthritic and inflamed joints that are the underlying cause of cervical stenosis. In addition, physical therapists will teach you how to properly use your neck during daily activities; thereby, reducing stress and inflammation of these joints.

  • Medication treatment:
    • Over-the-counter medications such as Advil or Tylenol may be used to treat your pain if symptoms are mild or moderate.
    • Anti-depressants have been used to treat chronic pain symptoms, including chronic pain caused by cervical stenosis.
    • Anti-seizure medications can be used to treat nerve pain caused by the pinching of nerves from cervical stenosis.
    • Opioids are used when pain symptoms are severe. Often, they are prescribed for short-term use while waiting for the beneficial effects of other therapies, or to allow a patient to tolerate exercise therapy.
  • Physical Therapy: Physical Therapy may be prescribed in conjunction with other treatments such as pain medication and/or epidural injections to help with your symptoms. Physical therapists can perform manual therapy and provide you with a program of stretching and exercises to help alleviate your symptoms. Physical therapists will also teach you how to strengthen muscles in your upper back, shoulders, and neck. As these muscles grow stronger, they will help stabilize the degenerated, arthritic joints and ligaments in your spine that are the underlying cause of cervical stenosis.
  • Epidural Steroid Injection: A physician performs a real-time image guided epidural injection to the nerve root thought to be the source of the patient’s symptoms. While corticosteroids do not fix cervical stenosis, they do help decrease the inflammation surrounding the neural tissue. The steroid acts like “a bucket of water thrown on the fire” decreasing the patient’s severe symptoms caused by inflammation.
  • Surgery: For patients with advanced stenosis, surgery may be necessary to prevent further spinal cord or nerve damage, and to maximize the chance of returning to normal function. Typically, the goal of surgery is to enlarge the narrowed passages where the spinal cord and nerves travel. If the joints are unstable, fusion may be required.
    • Laminectomy: A portion of the vertebrae known as the lamina is removed, along with overgrown joints, bone spurs, and thickened ligaments, to allow the spinal cord more room to travel.
    • Foraminotomy: A “roto rooter” procedure that cleans out the small tunnels that nerves use to exit the spinal column, giving these nerves more space.
  • Spinal Fusion: If the arthritic joints and ligaments are so diseased that they can no longer maintain the spinal column in proper alignment, stabilization surgery may be warranted in addition to the decompression provided by laminectomy or foraminotomy. This process of stabilization is known as spinal fusion surgery and entails realigning the bones and fixing them in the proper position using titanium screws and rods.

Summary

The dedicated team at Centers for Neurosurgery, Spine, and Orthopedics (CNSO) understands how cervical stenosis can impact your daily life.  By working with our team of renowned, board-certified neurosurgeons, orthopedic surgeons, non-surgical physicians, physiatrists, rehabilitation specialists, and certified physical therapists, you will receive comprehensive and coordinated care, so you can resume a healthy lifestyle.  CNSO offers multiple convenient locations spanning across northern New Jersey, including offices in Bergen, Passaic, Morris, Essex, Hudson, and Sussex Counties.  Northern NJ patients can learn more about cervical stenosis by contacting the providers at CNSO today.

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In order to provide an accurate diagnosis with the most effective treatment option for “back problems” and brain tumors, CNSO is led by neurosurgeons and orthopedic spine surgeons. Under the care of our award-winning neurosurgeons and orthopedic spine surgeons, Northern NJ patients can have the confidence that their medical condition will be handled with consideration for their comfort and long-term well-being as well as technical excellence.

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