Spinal Stenosis & Myelopathy
Spinal Stenosis & Myelopathy
Spinal stenosis means narrowing or constriction of the spinal canal, which contains the spinal cord and nerves. When the spinal cord compression is moderate or severe, it generally manifests as myelopathy.
Myelopathy can cause trouble walking, increased reflexes and spasticity, muscle weakness and/or numbness. The natural progression of this condition is usually a slow, gradual deterioration, although some patients present with a rapid decline of physical function and/or paralysis.
Spinal Stenosis
Myelopathy
Causes of Cervical or Lumbar Stenosis
A variety of causes can be attributed to cervical, lumbar, or spinal stenosis, including:
- Small Spinal Canal
- Bone Spurs of Osteoarthritis
- Thickening of Ligaments in the Spine
- Herniated or Bulging Disc
- Spinal Injury
- Tumor
Spinal Stenosis Diagnosis
Patients with significant arthritis seen on plain X-rays should be considered for additional studies such as MRI to evaluate the extent of spinal canal compromise. Often times flexion/extension X-rays are needed to evaluate for any dynamic instability.
Spinal Stenosis Treatment Options
Conservative Treatments
The treatment of spinal stenosis often depends on the severity of a patient’s symptoms and the severity of neurologic compression. Patients with mild or moderate stenosis may respond initially to conservative treatments such as oral anti-inflammatory medications and physical therapy. Epidural steroid injections may provide short-term improvement of pain symptoms.
Surgical Treatments
When a patient has severe spinal stenosis and myelopathy, or a patient with mild or moderate stenosis has not benefited from conservative modalities, surgical intervention is considered. Patients with severe spinal cord compression and/or severe myelopathy with weakness are candidates for surgery. The goal of surgery is to remove the compression from the spinal cord, to improve a patient’s pain and level of function, and to prevent further deterioration of function and worsening pain. If the majority of pressure is coming from osteophytes in the front of the spine, then an anterior approach may be considered. If the majority of the compression is occurring in the back part of the spinal cord, then a laminectomy or laminaplasty may be performed.
Occasionally, patients with severe, multiple-level stenosis will require both front and back of the neck surgery to adequately decompress and stabilize the spine. A cervical spinal fusion may be required and recommended in addition to the decompression component. Spinal instrumentation may also be utilized to impart immediate stability and increase the rate of bone healing and mending. Careful preoperative evaluation and delicate perioperative and postoperative management is particularly important to ensure success and avoid complications.
