Cervical canal stenosis
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Cervical canal stenosis is a general term that refers to the abnormal narrowing of the cervical spinal canal that compromises the nerve root and/or spinal cord resulting in radiculopathy and/or compressive myelopathy. The most common cause of cervical spinal canal stenosis is age-related degenerative changes, followed by acquired and congenital etiologies.
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Cervical spinal canal stenosis carries a reported prevalence rate of 1 in 1000 persons over 65 years of age and 5 in 1000 persons over the age of 50 in North America. There is a male predominance 9.
Risk factors include 9:
Patients with cervical spinal canal stenosis may be asymptomatic or present with neurological symptoms predominantly affecting the upper limbs and include 9:
arm or hand clumsiness
loss of hand dexterity
chronic neck pain
progressive loss of fine motor function of the hands
weakness of the upper limbs
decreased or absent sensation of the arms or hands
weakness of the proximal lower extremities
Cervical spinal canal stenosis in the setting of age-related degeneration is caused by 9,10:
intervertebral disc degeneration causing disc herniation and direct compression of the dural sac
facet joint degeneration causing joint instability and hypertrophy, which worsens the degree of dural sac compression
capsule and ligament thickening, and osteophytic and cystic changes further worsen the degree of compression
Cervical radiculopathy is caused by cervical canal stenosis at the level where the nerve roots exit the cervical spine and are commonly in the setting of disc herniation and/or facet joint hypertrophy.
Cervical myelopathy is caused by cervical canal stenosis leading to direct compression of the spinal cord. It can be associated with vascular compression with arterial involvement resulting in ischemia or venous involvement resulting in stasis. Chronic compression of the spinal cord results in inflammatory changes and edema and manifests clinically as a progressive decline of upper limb neurological function.
The etiology of cervical spinal canal stenosis is divided into congenital or acquired etiologies.
Congenital etiologies include 9,10:
anterior vertebral beaking or wedging
early vertebral arch ossification
vertebral segmentation failure
Acquired etiologies can be sub-classified into degenerative, systemic (metabolic), infectious, traumatic, and iatrogenic etiologies and include 9,10:
hypertrophy of the facet joints
hypertrophy of the ligamentum flavum
posterior longitudinal ligament ossification
previous spinal fusion
stenosis secondary to disc herniation
The canal-to-body ratio of Torg and Pavlov can be used to determine the presence of cervical canal stenosis 1-3.
On T2-weighted sagittal images, the Kang system can be used to classify cervical spinal canal stenosis 8.
The Muhle system can also be used to grade cervical spinal canal stenosis. The Muhle grading system utilizes a special device that facilitates T1- and T2-imaging of the cervical spine in positions from fifty degrees of flexion to thirty degrees of extension 7.
Treatment and prognosis
The objective of treatment of cervical spinal stenosis is based on two tenets, which are symptom control and further neurological and functional decline. These two tenets are used to guide decision-making in pursuing conservative or operative management.
Conservative management includes 9,10:
analgesics including acetaminophen and nonsteroidal anti-inflammatory drugs
cervical spine bracing
pulsed radiofrequency treatment
Operative management includes 9,10:
anterior approach discectomy or corporectomy
posterior approach laminectomy or laminoplasty
Cervical spinal canal stenosis can lead to:
epidural, subdural, or intradural abscess
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