spine

Stenosis

Cervical stenosis occurs when the spinal canal narrows and compresses the spinal cord and is most frequently caused by aging. The discs in the spine that separate and cushion vertebrae may dry out. As a result, the space between the vertebrae shrinks, and the discs lose their ability to act as shock absorbers. At the same time, the bones and ligaments that make up the spine become less pliable and thicken. These changes result in a narrowing of the spinal canal. In addition, the degenerative changes associated with cervical stenosis can affect the vertebrae by contributing to the growth of bone spurs that compress the nerve roots. Mild stenosis can be treated conservatively for extended periods of time as long as the symptoms are restricted to neck pain. Severe stenosis requires referral to a Spinal surgeon. Feel free to review our presentation in video format detailing stenosis and the influence it can have on the spinal cord called: Cervical Spondylotic Myelopathy.

cervical_myelopathy

When Surgery is Necessary

There are several surgical treatments available to treat cervical spine disorders. Factors that help determine the type of surgical treatment include the specifics of your disc disease, and the presence or absence of pressure on the spinal cord or spinal nerve roots. Other factors include your age, how long you have had the disorder, other medical conditions you have, and whether you have had previous cervical spine surgery.

When conservative treatment for neck pain does not provide relief, surgery may be needed. You may be a candidate for surgery if:

  • Conservative therapy is not helping
  • You experience progressive neurological symptoms involving your arms and legs
  • You experience difficulty with balance or walking
  • You are in otherwise good health

There are several different surgical procedures which can be utilized, the choice of which is influenced by the severity of your case. In a small percentage of patients, spinal instability may require that spinal fusion be performed, a decision that is generally determined prior to surgery. Spinal fusion is an operation that creates a solid union between two or more vertebrae. Various devices (like screws or plates) may be used to enhance fusion and support unstable areas of the cervical spine. This procedure may assist in strengthening and stabilizing the spine and may thereby help to alleviate severe and chronic neck pain.

The benefits of surgery should always be weighed carefully against its risks. Although a large percentage of neck pain patients report significant pain relief after surgery, there is no guarantee that surgery will help every individual.

If conservative treatment fails to relieve your pain over the course of 6 to 12 weeks, Dr. Pablo Pazmino may recommend a surgical option. The surgical procedure Dr. Pablo Pazmino recommends depend on the underlying condition, and he will discuss your options with you. In most instances, surgery not only relieves the pain, but also improves functioning and movement of the affected areas.

Surgery may be necessary for patients with progressive neurologic symptoms or severe pain that does not improve with other treatments. Surgery may be required if a disc fragment lodges in the spinal canal and presses on a nerve, causing significant loss of function. Surgical options in the neck are varied and depend entirely on the patient, the symptoms and the pathology. For some patients, a smaller surgery may be performed on the back of the neck that does not require fusing the bones together. These posterior approach options can include a laminoplasty.

Laminoplasty

The spinal cord and nerve roots in the neck are surrounded and protected by the bony arch of the cervical vertebrae. These vertebrae create a central opening called the spinal canal through which the spinal cord passes.

degenerated1

The nerve roots start within the spinal cord and pass through an opening between the vertebrae called the Neural Foramen. From there, they extend to other parts of the arms and hands.

Cervical Spinal stenosis, is a condition where there is narrowing of the spinal canal and often the neural foramen that causes compression of the spinal cord and/or nerve roots. This narrowing is caused by numerous factors including bone spurs, degeneration of the intervertebral disks and facet joints, and thickening of the ligaments. If the stenosis is severe and it starts to affect the spinal cord it is then referred to as Cervical Spondylotic Myelopathy. Cervical=Neck, Spondylotic=Arthritis and Stenosis of the Neck Myelopathy=Pathology involving the Spinal cord.

cervical_myelopathy

Among the symptoms spinal stenosis can produce are pain and/or numbness in the arms, clumsiness of the hands, and gait disturbances. Spinal stenosis, bone spurs press against the spinal cord, leading to a condition called myelopathy. Myelopathy can produce problems with the bowels and bladder, disruptions in the way you walk, and impairments with fine motor skills in the hands.

cervical_laminoplasty

Symptoms of spinal stenosis can include:

  • Neck pain
  • Arm pain
  • Numbness in the arms
  • Numbness in the hands
  • Numbness in the fingers
  • Clumsiness of the hands
  • Decreased Strength
  • Significant Weakness
  • Gait disturbances
  • Balance disorders
  • Headaches

Laminoplasty is a procedure intended to relieve pressure on the spinal cord while maintaining the stabilizing effects of the posterior elements of the vertebrae.

The laminaplasty procedure involves "hinging" one side of the posterior elements of the spine and cutting the other side to form a "door".

cervical_laminoplasty1

Here is a view from the back as well as an axial view which shows how Dr. Pablo Pazmino uses a small device to create the hinge within the bony arch of the vertebral bodies. As you watch the procedure below you can visualize how the space available for the spinal cord will increase.


cervical_laminoplasty2

As seen in the illustrations here, the door is then opened and held in place with wedges. In order to find the size of the appropriate wedge Dr. Pablo Pazmino uses tiny metal spacers to determine the custom size needed for each particular patient. The different spacer options are visualized below.

cervical_laminoplasty3 cervical_laminoplasty3 cervical_laminoplasty3

Next Dr. Pablo Pazmino uses tiny plates to hold these spacers in place. These pictures allow you to visualize how one level at a time Dr. Pablo Pazmino is creating a larger arch for the spinal cord. With an improved environment the spinal cord can now begin the healing process.

cervical_laminoplasty3 cervical_laminoplasty3 cervical_laminoplasty3

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This is the finalized Laminoplasty construction. By relieving pressure on the spinal cord it is the goal of laminoplasty to stop the progression of damage to the spinal cord and allow for as much recovery of function as possible.

cervical_laminoplasty6 cervical_laminoplasty6

Laminectomy

The spinal cord and nerve roots in the neck are surrounded and protected by the bony arch of the cervical vertebrae. These vertebrae create a central opening called the spinal canal through which the spinal cord passes.

degenerated1

 

The nerve roots start within the spinal cord and pass through an opening between the vertebrae called the Neural Foramen. From there, they extend to other parts of the arms and hands.

Cervical Spinal stenosis, is a condition where there is narrowing of the spinal canal and often the neural foramen that causes compression of the spinal cord and/or nerve roots. This narrowing is caused by numerous factors including bone spurs, degeneration of the intervertebral disks and facet joints, and thickening of the ligaments. If the stenosis is severe and it starts to affect the spinal cord it is then referred to as Cervical Spondylotic Myelopathy. Cervical=Neck, Spondylotic=Arthritis and Stenosis of the Neck Myelopathy=Pathology involving the Spinal cord.

cervical_myelopathy

Among the symptoms spinal stenosis can produce are pain and/or numbness in the arms, clumsiness of the hands, and gait disturbances. Spinal stenosis, bone spurs press against the spinal cord, leading to a condition called myelopathy. Myelopathy can produce problems with the bowels and bladder, disruptions in the way you walk, and impairments with fine motor skills in the hands.

Symptoms of spinal stenosis can include:

  • Neck pain
  • Arm pain
  • Numbness in the arms
  • Numbness in the hands
  • Numbness in the fingers
  • Clumsiness of the hands
  • Decreased Strength
  • Significant Weakness
  • Gait disturbances
  • Balance disorders
  • Headaches

Cervical laminectomy is a procedure to treat spinal stenosis. The back of the spinal canal is removed by cutting the lamina to provide more space for the spinal cord and nerve roots.

cervical_laminectomy1

cervical_laminectomy

By relieving pressure on the spinal cord it is the goal of cervical laminectomy to stop the progression of ongoing damage to the spinal cord. This then provides for a healthy environment within which the spinal cord and nerves can begin to recover and restoration of function may be possible.

In the neck, an anterior approach may be required. Anterior approaches can either be in the form of an Anterior cervical discectomy and fusion (ACDF) or a Cervical arthroplasty(ADR: Artificial Disc Replacement). This involves removing the entire disc to take the pressure off the spinal cord and nerve roots. The procedure for both an arthroplasty and a fusion are similar up to this point.

A fusion, (ACDF, an Anterior Cervical Discectomy and Fusion), is the current gold standard for treatment of the degenerated or herniated disc. With this procedure after the discectomy is performed, a spacer is placed inside the disc space, to restore the former height and curvature the collapsed disc was intended to assume, and a metal plate may be used for stabilization. The bone between the vertebral bodies will then grow through the center of the spacer and weld (or fuse) the vertebral bodies together. Once fused this completely eliminates painful motion from the involved area through a cervical fusion. Once the fusion mass is consolidated Dr. Pazmino will allow a progression of activities ranging from driving, work and sports. Final fusion occurs at 12-16 months. Patients are not required to wear a soft collar, unless needed for comfort while driving.

anterior_cervical

There are new minimally invasive methods for achieving an Anterior Discectomy and Fusion. For more information on these new techniques ask Dr. Pablo Pazmino to elaborate on the different options for your fusion.

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Many patients seek care for Cervical Laminectomy pain by Dr. Pablo Pazmino because as an Orthopaedic surgeon he is specifically trained to diagnose, treat, and help prevent problems involving the muscles, bones, joints, ligaments, and tendons. Although Dr. Pablo Pazmino confines his practices to Spinal pathology he also treats a wide variety of diseases, injuries, and other conditions, including cervical Laminoplasty.

When Should You Seek Medical Care?

If severe pain occurs following an injury (motor vehicle accident, diving accident, or fall), a trained professional, such as a paramedic, should immobilize you to avoid the risk of further injury and possible paralysis. Emergent medical care should be sought immediately.

Immediate medical care should also be sought when an injury causes pain in the neck that radiates down the arms and legs.

Radiating pain, or numbness in your arms or legs which causes weakness in the arms or legs without significant neck pain should also be evaluated.

If there has not been an injury, you should seek a Spinal Evaluation with Dr. Pablo Pazmino when pain is:

  • Continuous and persistent
  • Severe
  • Accompanied by pain that radiates down the arms or legs
  • Accompanied by headaches
  • Accompanied by numbness, or tingling
  • Accompanied by weakness!

Many patients seek care for Stenosis pain by Dr. Pablo Pazmino because as an Orthopaedic surgeon he is specifically trained to diagnose, treat, and help prevent problems involving the muscles, bones, joints, ligaments, and tendons. Although Dr. Pablo Pazmino confines his practices to Spinal pathology he also treats a wide variety of diseases, injuries, and other conditions, including Neck Pain.

 

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