Most cervical problems are due to degenerative changes that occur in the
discs and joints of the neck. Degenerative changes that affect the structures
of the spine can cause the spinal canal to become too narrow, a condition
called spinal stenosis. This may lead to pressure on the spinal cord. Bone
spurs that stick into the spinal canal take up space, making the spinal canal
smaller. They can press against the spinal cord or nerve roots.
Pressure on the spinal cord from spinal stenosis can cause symptoms of myelopathy. Myelopathy may impair normal walking, hand and finger use, and bowel and bladder function. Doctors take these symptoms very seriously because severe myelopathy that is not treated may lead to permanent nerve or spinal cord damage. Pressure on nearby nerve roots can cause radiculopathy and may produce pain, weakness, or sensory changes in the area supplied by nerves that go from the cervical spine to the shoulder, arm, or hand.
Pressure on the spinal cord from spinal stenosis can cause symptoms of myelopathy. Myelopathy may impair normal walking, hand and finger use, and bowel and bladder function. Doctors take these symptoms very seriously because severe myelopathy that is not treated may lead to permanent nerve or spinal cord damage. Pressure on nearby nerve roots can cause radiculopathy and may produce pain, weakness, or sensory changes in the area supplied by nerves that go from the cervical spine to the shoulder, arm, or hand.
Epidural Steroid Injection (Nerve
Block)
If other treatments do not relieve
your neck pain, you may be given an epiduralsteroid injection (ESI), also called a nerve block. An ESI places a
small amount of cortisone into the bony spinal canal. Cortisone is a strong
anti-inflammatory medicine that may control the inflammation surrounding the
nerves and may ease the pain caused by irritated nerve roots. This injection is
often used when other conservative measures do not work, or in an effort to
postpone surgery. This treatment is not always successful but may provide
short-term help. Learn more about spinal injections.
Physical Therapy
If your condition is causing only
mild symptoms and does not appear to be getting worse, your doctor may have you
work with a physical therapist. A well-rounded rehabilitation program assists
in calming pain and inflammation, improving your mobility and strength, and
helping you do your daily activities with greater ease and ability.
In mild cases, nonsurgical
treatments offer ways to control symptoms and enable you to improve without
surgery. You may be issued a neck brace to hold your neck steady, reducing
extra strain. You will need to limit your activities, especially heavy and
repeated movements of the arms and neck. Therapists use electrical stimulation
to ease muscle spasm and pain. Treatments may also include cervical traction to
gently stretch the joints and muscles in the neck. Therapy sessions may be
scheduled two to three times each week for up to six weeks.
The goals of physical therapy are to
help you
·
learn correct posture and body
movements to minimize the effects of stenosis
·
maintain appropriate activity levels
·
identify symptoms of stenosis that
require medical attention
·
learn ways to manage your condition
Surgical Treatment
Cervical myelopathy can be a serious
problem. The pressure on the spinal cord usually will not go away without
surgery, and the symptoms may continue to get worse. If you do not improve with
non-operative care, your doctor may suggest surgery.
There are several surgical
procedures used to treat cervical spinal stenosis that is causing cervical
myelopathy; all have the same goal-to relieve the pressure on the spinal cord
by making the spinal canal larger.
Your surgeon may suggest an
operation called a laminectomy,
in which the backside of the vertebrae is opened to allow more room for the
spinal cord. Discectomy, the removal of one or more discs, may be suggested if
stenosis is coming from problems of disc herniation. This surgery may be done
from the front or back of the spine. Or your surgeon may suggest an operation
that is done from the front of the neck-a corpectomy
and strut graft. This operation involves removing the discs and
vertebral bodies in the area where problems are occurring. Bone spurs that are
pushing into the spinal cord are also removed.
The vertebrae are then replaced with a solid piece of bone graft (called a
strut graft). The strut graft heals over time to create a solid fusion of the
spine where the vertebral bodies have been removed.
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