||People who suffer chronic pain in their backs or necks are often the victims of a herniated disc.
As you age, the joints of your spine sometimes degenerate, causing tightening, or narrowing, of your spinal canal. This is called cervical stenosis and can lead to compression of the spinal cord which is called myelopathy. Cervical stenosis with myelopathy affects your extremities and compromises your motor skills. If left untreated, it could lead to paralysis.
• Pain in neck or arms or legs
• Weakness, stiffness, or clumsiness in the hands when buttoning a shirt, turning a doorknob, opening a jar, etc.
• Weakness in legs, or difficulty walking with balance difficulty.
• Urinary urgency
In many cases, cervical stenosis with myelopathy is first diagnosed after a patient visits their doctor because of arm pain.
To determine if you have cervical stenosis with myelopathy, Dr. Blankenship will begin by asking you questions and by performing a physical examination that may reveal findings such as:
• Increased reflexes in the knee and ankle (hyperreflexia)
• Rapid foot beating triggered by turning the ankle upward (clonus)
• Extension of the big toe when the foot is stroked (Babinski’s sign)
• Contraction of the thumb and index finger after flipping the middle finger (Hoffman’s sign)
• Compromised coordination evidenced by tandem walking
Any one or combination of these findings my lead Dr. Blankenship to suspect spinal cord dysfunction. If he does, then he may request you to undergo an MRI scan or a cervical spine x-ray in order to either confirm or rule out the diagnosis.
Nonsurgical treatment is used to reduce pain and increase function, but do nothing to change the spinal canal narrowing. This treatment may include analgesics to control pain, non-steroidal anti-flammatory drugs (NSAIDs), corticosteroids, as well as other pain management treatments. It’s important that you let Dr. Blankenship know about all prescription medications you are taking, as well as any over-the-counter, natural, herbal, or alternative medications.
In addition to medication, Dr. Blankenship may also prescribe a physical therapy or exercise program that includes stretches to restore flexibility, cardiovascular exercise to build endurance and improve circulation, and strengthening exercises to improve function.
Surgery to decompress the spinal canal is the most effective and long-term treatment for cervical stenosis with myelopathy. Dr. Blankenship may recommend surgery if you fail to respond to nonoperative treatment. Dr. Blankenship may recommend surgery if you fail to respond to nonoperative treatment or if your degree of myelopathy puts you at risk for further loss of function..
There is no guarantee that surgical decompression surgery will improve your symptoms. The goal is to remove pressure from the spinal cord and spinal nerves, arrest the progression of the condition, and stabilize your neurological condition.
This type of surgery can be performed from the front of the neck (anterior), or from the back of the neck (posterior).The first is an anterior cervical discectomy and fusion that removes the disc and bone spurs pinching the spinal cord and spinal nerves. The disc is replaced with an implant to fuse and support the spine. If more than one level of the spine is involved, Dr. Blankenship may also perform a corpectomy to remove the disc above and below the vertebra and the intervening vertebra to completely remove pressure from the spinal cord. Dr. Blankenship then replaces the bone with a titanium cage filled with bone to stabilize the spine. Eventually, if successful, bone will fuse through and in the cage. For either procedure a titanium plate is then placed on the front of the spine for added stabilization.
Two common procedures in posterior surgery are laminectomy and laminaplasty, both designed to remove pressure from the spinal cord and spinal nerves. In a laminectomy, Dr. Blankenship removes the rear elements of the vertebra known as the “lamina.” In a laminaplasty, he will remove part of the bony arch and create a hinge that is “opened” to make room for the spinal cord.
It usually takes about two to four weeks before you’re able to return to all activities. Dr. Blankenship will most likely prescribe a rehabilitation program to guide your return to normal life.