MR KEITH GOMES

Melbourne Brain and Spinal Neurosurgeon

Cervical Spinal Stenosis

Spine Conditions

Cervical Spinal Stenosis is a condition that usually affects patients over the age of 50 and results from the narrowing of the open space (spinal canal) in the cervical spine.

Normally, the spinal cord and cervical spinal nerves are encased in a fluid sac and are protected by the vertebrae (bones). In the degenerative process (‘wear and tear’) of the spine, this space narrows which results in pressure on the spinal cord and nerves. This pressure on the spinal cord and nerves is usually the cause of your symptoms.

Cervical spinal stenosis is usually a result of many factors. During the degenerative process, discs lose height and they can bulge into the spinal canal. This process results in the loss of normal cervical spine alignment and stability which causes strain on facet joints and surrounding structures. The body attempts to reduce this instability by growing bone around the disc which forms an osteophyte (bony spurs), the facet joints enlarge to try and fuse together and the ligaments enlarge.

The resultant osteophytes, bulging discs, ligament hypertrophy (growth) and enlarged facet joints all protrude into the spinal canal, causing it to become narrow which produces stenosis. Other less common causes of cervical stenosis include Infection and spinal tumours.

Signs & symptoms

Signs and symptoms that patients experience include:

Pain that travels down the arm (brachalgia) and sometimes into the fingertips or between the shoulder blades. This is usually from compression on a nerve in the neck
Neck pain that can be quite generic in nature or focused at a particular spot. Neck pain can be accompanied with brachalgia.
Weakness in the hands and difficulty working with them for example difficulty lifting a cup.
Sensation changes such as numbness or pins and needles (paraesthesia) in the arms or legs
Bowel or bladder symptoms.
Progressive stiffness in the arms or legs.
Loss of balance when standing or walking
The reflex at the back of your elbow may disappear.

What tests are needed?

Magnetic Resonance Imaging (MRI) and/or Computed Tomography (CT) will be performed when planning surgery to help confirm diagnosis, understand the anatomy, show how much diameter of the canal is reduced and the degree of narrowing being produced by disc bulging/prolapse. X-rays are performed to show spine alignment, if the discs have lost height and if there are osteophytes (bony spurs).

How is it diagnosed?

Diagnosis is made from the findings of the clinical examination, your symptoms and relevant tests.

When surgery will be considered

Surgery will be considered as the last resort when you have ongoing symptoms despite non-surgical treatment.
Significant brachalgia.
Significant signs of Myelopathy – upper and/or lower limb weakness
Progressive balance problems
Sensation changes such as numbness or pins and needles (paraesthesia).

Surgical treatment

The aims of surgery for cervical spinal stenosis are to relieve compression to the spinal cord and spinal nerves while maintaining or improving stability to the cervical spine so that symptoms improve. Mr Gomes performs a number of surgeries for this condition. A procedure tailored to your individual circumstances will be recommended by Mr Gomes who will discuss the risks and benefits of the operation with you.

Cervical Laminectomy – involves removing the bony roof overlying the spinal cord at selected levels and is approached from the back of the neck
Anterior Cervical Discectomy and Fusion (ACDF) – permanently connects two or more vertebrae in your spine while decompressing the spinal cord and nerves. It is usually needed if there is severe disc degeneration associated with loss of height and/or subluxation (slippage between the vertebrae.)
Cervical Disc Arthroplasty – usually confined to one level in selected patients. Like an ACDF, the disc is removed but instead of fusion an artificial disc is placed in position.
Foraminotomy – this is a more selective removal of part of the bony roof and may be suitable for some patients.
Cervical Laminoplasty – the aim of this procedure is to decompress the central cervical canal like a laminectomy, but the bony roof is preserved and hinged away on one side instead.

For all appointments and enquiries, please phone 03 8318 4929

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