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Cervical Stenosis

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Depending on the severity of symptoms, patients may be offered surgical or nonsurgical options. Nonsurgical options can help manage symptoms, but they usually do not cure the underlying problem. Surgical treatment is the only cure for cervical stenosis and can improve symptoms in up to 90% of patients.

Nonsurgical options include neck immobilization, non-steroidal anti-inflammatory drugs (NSAIDS), e.G., ibuprofen, naproxen, aspirin, physical therapy and steroid injections.

Surgical options aim to relieve pressure on the spinal cord and provide stability to the neck. Common procedures are posterior cervical laminectomy, discectomy and fusion, or corpectomy.

Spinal Stenosis Treatment

Spinal stenosis is a narrowing of the canal in your spinal column that affects mostly people age 50 and older. Nothing can cure it, but there are things you can do on your own, under your doctor's guidance, to enjoy an active life.

Some of the best ways to treat the complications and pain of spinal stenosis are also the simplest.

Most doctors will suggest you start with exercise and over-the-counter medications before thinking about something more involved such as surgery.

A physical therapy program can go a long way toward easing your symptoms and can also help with:

Flexibility

Balance

Endurance

One study found that a formal physical therapy program was just as good as surgery to improve everyday function. In that study, people did bends, pelvic tilts, standing squats, and other exercises.

Spinal stenosis exercises

Exercise, along with good eating habits, can help you slim down if you're overweight. This will ease the strain on your spine. Even if you do decide to have surgery, exercising afterward can boost your recovery. But you'll need to start slowly. Talk with your doctor or physical therapist about exercises that can help you:

Gain flexibility: Stretching exercises can help with pain and make it easier to hold and move your neck and spine in healthier ways.

Strengthen your muscles: A series of exercises called stabilization training can help build up the muscles that support your neck and give them better balance. Like stretching, these are simple exercises you can do at home without any special equipment.

Boost your fitness: Aerobic exercises, ones that get your heart and breathing rates up, release chemicals called endorphins that can ease pain. Examples of aerobic exercise include bicycling or swimming.

There's no one right way to exercise with this condition -- and you don't want to overdo it. Ask your doctor or a physical therapist for ideas.

Sometimes, you can wear corsets or braces around your stomach to make it easier to exercise. If you wear them too much, though, they can backfire and cause your muscles to get weaker. Ask your doctor about it.

Spinal stenosis is commonly treated with medication, both over-the-counter and prescription.

Primary medications utilized to treat neuropathic pain include Duloxetine, Gabapentin, and Pregabalin.

Epidural injections may be considered but there is limited evidence that they provide lasting benefit. Nevertheless, they are often times tried as they may be the final option prior to surgical considerations.

Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce pain and inflammation. Examples of over-the-counter NSAIDs include aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve). Typically NSAIDs are not a mainstay of treatment. They are also often avoided in patients who are older, which is where stenosis is typically more prevalent. 

Analgesics help relieve pain but don't affect inflammation. Acetaminophen (Tylenol) is a common analgesic used for spinal stenosis.

Antidepressants. Some types of these can help with chronic pain. Amitriptyline is the most common.

Anti-seizure drugs. Your doctor may prescribe these to help with pain caused by damaged nerves.

Interspinous spacer. This is another minimally invasive procedure sometimes considered in which the doctor makes a small cut and inserts the device through a tube, then expands it once it's in place.

If none of these help, your doctor may prescribe something stronger, such as an opiate. These drugs can give you short periods of pain relief, but they can be dangerous over a long time because they can be addicting and cause other health effects.

Side effects of spinal stenosis medications

All medications, even over-the-counter medicines, can have side effects. Too many NSAIDs can cause ulcers and other stomach problems and, especially among older people, may increase the chance of heart attacks and strokes. They might also interact with other medicines.

Antidepressants can make you sleepy, so it's best to take them at bedtime. Other possible side effects include blurred vision, constipation, dry mouth, lightheadedness, problems peeing, weight gain or loss, sweating, and trouble performing sexually.

Anti-seizure drugs also can have side effects, like drowsiness, dizziness or confusion, swelling in your feet and legs, or kidney issues. But those aren't likely to happen with smaller doses. In some cases, these medicines can make people have occasional suicidal thoughts. If that happens, call your doctor right away.

Always check with your doctor before taking any medications, even those that don't need a prescription.

Certain injections have the same effect as many medications. Doctors use two basic types for spinal stenosis:

Corticosteroids can be injected straight into the area around the spinal cord. This is called an epidural injection. Like NSAIDs, steroids work on inflammation and pain. An anesthesiologist or other specialist gives the injection.

Nerve blocks are anesthetics injected near the damaged nerves. Everybody responds differently to these injections. You may get relief for a long time, for a short period, or not at all.

This procedure, called percutaneous image-guided lumbar decompression (PILD), removes part of a ligament that's gotten thicker. This keeps the ligament from affecting the nerve root and frees up space in the spinal canal.

You don't have to be asleep for PILD, so it may be an option for people who can't have surgery because of other medical issues.

The two most common alternative therapies are acupuncture and chiropractic treatment.

Acupuncture: This is a traditional Chinese practice in which someone inserts tiny, flexible needles into you or puts pressure on specific parts of your body to ease pain.

Chiropractic care: Chiropractors try to adjust your spine to reduce pain and improve movement. Some also use traction, which involves pulling bones further apart to make more room for the nerves. Although there isn't a lot of scientific evidence for this, some people say that traction helps them.

You may also benefit from yoga, tai chi (an ancient Chinese exercise routine), or massage.

If these treatments don't work, your doctor may suggest surgery, especially if:

You're in a lot of pain

You have trouble walking

You can't control your bladder

In fact, your doctor may recommend surgery first if you have severe symptoms. Like other treatments, surgery is not a cure, but it can help with pain and function.

Your doctor may talk to you about these types:

Laminectomy. This is the most common one. A doctor takes out the bone, spurs, and ligaments that are putting pressure on the nerves.

Laminotomy. Your doctor makes a small hole in the back part of the affected vertebra, called the lamina. The hole should be just big enough to relieve some pressure in the area.

Laminoplasty. This procedure creates space in the spinal canal in your neck. A metal hinge is put on the lamina to bridge the gap of the opened-up area.

Discectomy. With this procedure, the injured part of a bulging, or herniated, disc is taken out to ease pressure on your nerves or spinal cord. It can be done through a cut in your spine or neck that lets your doctor get to it directly or with smaller cuts and tiny instruments.

Spinal fusion. Doctors sometimes do this along with a laminectomy. It involves joining vertebrae together to reduce movement within the spine.

Foraminotomy. A doctor expands the portion of the vertebrae where the nerve roots branch out to the rest of the body.

Minimally invasive surgery. This takes out parts of the lamina or a disc in a way that doesn't damage healthy tissue or raise your chances of needing spinal fusions.

Recovery can be a few days or up to 3 months. Surgery helps many people but there are also risks, such as blood clots.

Management Of Back Pain

There can be many causes of back pain including accidents, strains, and injuries. Two types of back injury are spondylolisthesis and cervical radiculopathy. Both have their own set of symptoms, causes, and treatments.

The spine, or backbone, is made up of a column of 33 bones and tissue extending from the skull to the pelvis. These bones, or vertebrae, enclose and protect a cylinder of nerve tissues known as the spinal cord. Between each one of the vertebrae is an intervertebral disk, or band of cartilage serving as a shock absorber between the vertebrae. The types of vertebrae are:

Cervical vertebrae: the seven vertebrae forming the upper part of the spine

Thoracic vertebrae: the 12 bones between the neck and the lower back

Lumbar vertebrae: the five largest and strongest vertebrae located in the lower back between the chest and hips

The sacrum and coccyx are the bones at the base of the spine. The sacrum is made up of five vertebrae fused together, while the coccyx (tailbone) is formed from four fused vertebrae.

The causes of back pain can be complex. Some causes of back pain include accidents, muscle strains, and sports injuries.

In addition to performing a complete history and physical exam for your back pain, your doctor may suggest one of the following diagnostic studies:

X-rays, which can be used to provide detail of the bone structures in the spine and to check for instability (such as spondylolisthesis, see below), tumors, and fractures

CT scans, which can identify specific conditions, such as a herniated disc or spinal stenosis

MRI scans, which can provide details about the backs' discs and nerve roots. MRI scans are most commonly used for pre-surgical planning

A number of other imaging and electrical studies may also be used to identify back problems, and some injections are used for diagnostic purposes as well as for pain relief.

Two main types of back injury include:

Spondylolisthesis: This is a slipping of vertebra that occurs, in most cases, at the base of the spine. Spondylolysis, which is a defect or fracture of one or both wing-shaped parts of a vertebra, results in this vertebra slipping backward, forward, or over a bone below.

Cervical Radiculopathy: Cervical radiculopathy is the damage or disturbance of nerve function that results if one of the nerve roots near the cervical vertebrae is compressed. Damage to nerve roots in the cervical area can cause pain, weakness, and the loss of sensation in the neck, arms, or shoulders, depending on where the damaged roots are located.

Other types of back injuries include fracture/compression fractures, degenerative disc disease, disc herniation, radiculopathy, spondylolysis, spondylolisthesis, strain, facet arthritis, and stenosis.

There are many causes for Spondylolisthesis. A vertebra might be defective from the time a person is born, or a vertebra may be broken by trauma or a stress fracture. In addition, vertebrae can be broken down by infection or disease.

Symptoms of Spondylolisthesis may include:

Lower back pain

Muscle tightness and stiffness

Pain in the buttocks

Pain radiating down the legs (due to pressure on nerve roots)

Muscle weakness

Spondylolisthesis is treated with the strengthening of supportive abdominal and back muscles through physical therapy. Acetaminophen or nonsteroidal anti-inflammatory medicines, such as ibuprofen (Advil, Motrin), ketoprofen (Frotek), and naproxen (Aleve, Naprosyn) may help with pain. Epidural steroid injections may also be effective. 

Medications for neuropathic pain secondary to radiculopathy are often considered (duloxetine, gabapentin, pregabalin).Sometimes a medrol/steroid pack is considered for flare-ups related to the disc or radiculopathy (pinched nerve). This may also be avoided if an individual suffers from preexisting diabetes as steroids can temporarily raise blood glucose levels.Muscle relaxants may also be considered on occasion.

For patients who continue to have severe pain and disability despite these treatments, there are options such as decompressive laminectomy, a procedure in which the spinal canal is widened (to provide more room for nerves and a spinal fusion is performed to stabilize the spinal cord), with or without surgical fusion (arthrodesis) of the vertebra, or the use of an implanted device to stabilize the vertebrae in the lower back while permitting more normal movement.

In cervical radiculopathy, damage can occur as a result of pressure from material from a ruptured disc, degenerative changes in bones, arthritis, or other injuries that put pressure on the nerve roots. In older people, normal degenerative changes in the discs can cause pressure on nerve roots. In younger people, cervical radiculopathy tends to be the result of a ruptured disc. This disc material then compresses the nerve root, causing pain.

The main symptom of cervical radiculopathy is pain that spreads into the arm, neck, chest, and/or shoulders. A person with radiculopathy may experience muscle weakness and/or numbness or tingling in fingers or hands. Other symptoms may include lack of coordination, especially in the hands.

Cervical radiculopathy may be treated with a combination of pain medications such as acetaminophen (Tylenol), or nonsteroidal pain medication such as ibuprofen (Advil, Motrin), ketoprofen (Frotek), naproxen (Aleve, Naprosyn), and physical therapy. Steroids may be prescribed either orally or injected epidurally (into the epidural space that surrounds the spinal cord).

Physical therapy might include gentle cervical traction and mobilization, exercises, and other modalities to reduce pain.

If significant compression on the nerve exists to the extent that motor weakness results, surgery may be necessary to relieve the pressure.

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