Cervical Stenosis (radiculopathy)
Cervical stenosis (radiculopathy) is the narrowing of the spinal canal (where the spinal cord and nerves originate). Cervical stenosis is most often caused by a number of factors which combine to cause a critical level of spinal cord compression, at which time symptoms may develop.
Radiculopathy (compression of the nerves) is distinct from myelopathy (compression of the spinal cord) in several ways.
Radiculopathy typically involves only the pattern of skin and muscles innervated by that single nerve root, while myelopathy can involve the entire arm and hand. Radiculopathy is often unilateral, affecting only one arm, while myelopathy more commonly affects both arms (and can affect the legs as well).
Myelopathy less commonly causes arm pain, while radiculopathy most commonly starts with arm pain. Myelopathy can cause clumsiness of the hands such as changes in handwriting and clumsiness of walking, while radiculopathy usually does not.
What are treatment options for cervical radiculopathy?
As radiculopathy will resolve in most people without surgery, nonoperative ("conservative") care is the initial treatment of choice for the majority of patients. However, severe weakness related to radiculopathy that is not improving, or is progressive, may prompt surgery even in the absence of conservative treatments. Patients with weakness should see a cervical spine surgeon early in the course of their treatment.
For most patients, the acute or severe pain lasts 3-6 weeks and the episode lasts 3-6 months. Initial care is normally initiated by the patient's primary care physician, and often involves one or more of the following:
- Avoiding trauma and re-injury
- Cervical immobilization with a cervical brace or collar
- Medications: Non-steroidal anti-inflammatories such as ibuprofen, muscle relaxers, or oral steroids
- Physical therapy, sometimes including cervical traction
- Spinal injections for pain relief: Nerve blocks or epidural steroid injection
If surgery is ultimately necessary, many insurance carriers require documentation of conservative treatments prior to their approval of surgery.
There are several options for treatment, our spine surgeons will normally recommend one of the following, based on the patient's specific anatomy and pathology.
Anterior cervical discectomy with fusion (ACDF) is surgery from the front of the neck. The entire disc is removed from the affected level, along with any associated bone spurs, to decompress the spinal cord and nerve roots. The level is then fused with a spacer made up of either bone or a synthetic material and often an anterior cervical plate.
Anterior arthroplasty (artificial disc) is similar to the ACDF surgery. This is an approach from the front of the neck to remove the disc and associated bone spurs. However, rather than fusing the spine, a mechanical artificial disc is placed to preserve motion.
Posterior foraminotomy (opening of the nerve foramen from the back of the neck). This is a surgery from the back of the neck, and can be done in an open or minimally invasive fashion. Columbia Orthopaedic Group spine surgeons remove a portion of bone from the back of the spine to decompress the nerve in the foramen. Our spine surgeons may also remove a portion of the disc, if herniated, through this approach.
The exact surgical treatment will depend on a number of factors specific to your condition, and oftentimes there is more than one way to treat the specific problem. Multiple factors need to be considered when determining the best surgical treatment option for any given patient. It is important to recognize that one operation is not necessarily superior to the others in every case.
Non-Operative Pain Management
Orthopaedic Spine Specialists
What's Next? Treatment Options...
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Columbia Orthopaedic Group
1 South Keene Street
Columbia, Missouri 65201
During your initial consultation, you will have the opportunity to meet our team, learn about our services, and discuss potential treatment options best suited for your needs.