Cervical Stenosis Explained
The cervical spine is composed of seven bones called vertebrae. These seven special bones make up the neck. Vertebrae protect the spinal cord. Within the vertebrae is the spinal canal. The spinal cord runs through the spinal canal. The spinal cord is a very important part of the peripheral nervous system. It is composed of a system of nerves that are responsible for movement of the upper extremities. The spinal cord in this region is also responsible for sensation in the upper extremities as well as control of the bladder and bowels.
Between the vertebrae are joints known as intervetebral discs. These discs act as shock absorbers in the neck. Over time, the intervetebral discs lose fluid and their shock absorbing capabilities. A condition called cervical stenosis can develop. As the discs lose fluid, they collapse. The entire spinal canal gets smaller. Continued wear and tear on the compromised joints causes bone spurs to form around nerves. As the condition progresses, nerve function is impaired. When the nerves become affected, a condition called cervical myelopathy occurs.
In the initial stages, cervical stenosis may not cause symptoms. When patients begin exhibiting symptoms, the symptoms are pain in the upper extremities and neck. They may suffer difficulty in moving their arms or legs. These symptoms are indicative of advanced disease, which is cervical myelopathy. As the disease progresses to the late stages, patients may suffer incontinence of their bladder and bowels. Progression may occur over a period of years or it can happen quickly.
The best method of prevention of cervical myelopathy is early detection of cervical stenosis. Tests that can be performed to detect the disease are computed tomography (CT) scans and magnetic resonance imaging (MRI). These scans allow for excellent visualization of the spinal canal and provide a way to measure progression. MRI’s allow for actual visualization of the spinal nerves. It is the best test for diagnosing cervical stenosis. A doctor may perform an array of physical tests to determine the level nerve function during the physical assessment.
Operative and Non-operative Treatments for Cervical Stenosis
There are two types of treatment for cervical stenosis, operative and non-operative. Treatment is dependent upon the stage of the disease. Severe pain, extreme fragility and impaired walking ability warrant surgery. For patients who suffer to a lesser degree, physical therapy is the treatment of choice for cervical stenosis.
The damage to the spinal canal in cervical stenosis is irreversible. Physical therapy is geared at reducing pain and maintaining optimum function. Therapists help patients increase function in affected extremities. Physical therapy helps patients manage their pain and avoid surgical intervention.
The goal of cervical stensosis physical therapy is to improve flexibility in affected areas including the neck, the arms and the legs. Flexibility is achieved through a series of stretching exercises. Along with increasing flexibility, therapists help patients improve their circulation through cardiovascular exercise. Cardiovascular exercises a patient may engage in include walking on treadmills and swimming. Therapists may also add strength training as well. These exercises are performed under the therapist’s supervision. However, they will teach patients exercises they can perform at home.
Physical therapy treatment for cervical stenosis takes time. It may take several months. If physical therapy remains ineffective, a patient may require surgical intervention. The primary care physician will refer the patient to a surgeon and the surgeon will make the recommendation for the best intervention.