Spinal canal stenosis of the cervical spine

In the area of the neck medulla there are nerves to supply the arms, among other things. A possible symptom of cervical tightness is therefore, in addition to neck pain, pain in the arms (brachialgia) and hands, which can extend to tingling and numbness. A weakness in arms and hands and fine motor clumsiness can also be indicative.

But not only the nerves supplying the upper half of the body run in the area of the cervical spine, but also the nerves supplying the lower part of the body. For example, if the spinal cord is severely compressed, this can also lead to pain in the legs and gait insecurity, and even a loss of control over stool and urine discharge is conceivable. Immediate consultation with a physician is urgently required here.

Here too, a conservative approach to therapy with painkillers and physiotherapy should always be attempted first. However, in the case of damage to the spinal cord, which becomes apparent through neurological deficits such as paralysis, a surgical procedure should be urgently considered. There are two possible access routes for the operation.

One from the front (ventral) and one from behind (dorsal). With access from the front, intervertebral disc or bony parts can be removed. In the dorsal approach, vertebral arches can be sawed open or parts of the ligamentous apparatus can be removed or split, which also leads to a relief of the spinal cord.

Surgery for spinal canal stenosis

Also known as decompression treatment, spinal canal stenosis surgery is performed when the risk has been properly weighed against the benefits by the neurosurgeon. It cannot be performed without risks, but is often indispensable, because severe untreated spinal canal stenosis can lead to paraplegia.The aim of decompression treatment is to give the constricted spinal cord enough space again so that sufficient nerve impulses can be passed on unhindered in this area. The operation is performed using an operating microscope on the patient lying on his back.

In total, an approx. 3-4 cm long incision allows access to the spinal region of the cervical spine. The intervertebral disc of the affected vertebra is removed using a surgical microscope.

Subsequently, the structures that led to the narrowing of the spinal canal are separated out. Once these structures have been removed, the area where the intervertebral disc of the cervical spine was is filled with a plastic construction. The hospital stay is about three days.

The neck must remain immobilized for 2 days after the operation. Afterwards, physiotherapeutic follow-up treatment begins, which can last several weeks to months. In general, there is no more narrowing at the site where the spinal canal stenosis occurred.

However, such a narrowing can occur again in other places. If a conservative treatment, i.e. physiotherapeutic or drug treatment, is not sufficient to achieve the necessary success, it must be considered whether a surgical procedure is appropriate. Here it is necessary to weigh the risks against the benefits of an operation.

Especially if the symptoms persist for months, worsen and also involve neurological complaints and deficits, surgery must be seriously considered. The operation is performed under general anesthesia. It is performed in special centers and is usually minimally invasive, i.e. with a keyhole surgical technique.

Mostly a surgical microscope is used for this purpose, which gives the surgeon a good view and access to the spine. The operation is also known as decompression laminectomy. After disinfection and skin incision, the surgeon removes parts of the vertebral body.

These parts are vertebral arches, spinous processes and facet joints. Sometimes it may also be necessary to remove a disc completely. Then the surgeon can see through his microscope which structure leads to the corresponding narrowing of the spinal canal.

In most cases, these are calcifications or bony protrusions as well as degenerative changes that lead to such a narrowing. These protrusions or calcifications are then removed. Sometimes parts of the disc are re-inserted, sometimes they are replaced by a plastic preparation.

In some cases, it may also be necessary to stiffen the area in the spine. In this case, two opposite vertebral bodies are connected by a screw or nail and thus immovably bound to each other. Since this usually only affects 2 joint bodies, this stiffening has no effect on the overall mobility of the spine.

After an operation, the patient usually has to stay in the clinic for 3-5 days. After that the rehabilitation phase begins, which also consists of extensive physiotherapeutic treatment. 2-3 times a week a physiotherapist should be visited and appropriate exercises should be performed.

These exercises usually lead to a build-up of muscles, which should ensure that the spine is relieved. In addition, the patients are also shown exercises that they can use in everyday life and which should ensure that corresponding bad posture no longer occurs. This is the only way to prevent a renewed slipped disc of the lumbar spine or spinal canal stenosis in subsequent years.