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.
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.
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
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 laminoplasty procedure involves "hinging" one side of the posterior elements of the spine and cutting the other side to form a "door".
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.
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.
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.
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.
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
- 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 Cervical Laminoplasty 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 Arm Pain and Weakness.