Cervical Spinal Stenosis Flashcards
True or False: Cervical spinal stenois is associated with spondylosis (degnerative process) and is the most common cause of spinal cord disorders in pts over 55
True
What is the difference between Degenerative, congenital, and traumatic cervical spinal stenosis?
Degenerative- osteophyte formation, degenerative disc, hypertrophy of ligamentum flavum
Congenital-present due to spinal development
Traumatic-single incident
What is cervical spinal stenosis?
narrowing of the spinal canal which can be central or lateral
What structures are implicated with cervical spinal stenosis?
Bony Structure
- osteophytes on vertebral bodies posterior or posterior lateral
- facet joint osteophytes
- uncovertebral joint osteophytes
Soft Tissue Structures
- disc protrusion or calcification
- ossified posterior longitudinal ligament
- ligamentum flavum hypertrophy and buckling
Which motion of the neck widens the central spinal canal? Which narrows the canal? How does rotation change the spinal canal?
flexion widens the canal by 31%
extension narrows the central canal by 20%
at 20 and 40 degrees of rotation there is 15% and 23% ipsilateral neuroforaminal narrowing but also 9% and 20% contralateral neuroforaminal widening
What 3 symptom complexes are associated with symptomatic spondylosis?
- Axial spine pain (most common in middle ages)
- Radicular Pain (herniated disc, neuroforaminal stenosis or both)
- Myelopathy (central stenosis leading to cord compression)
What is cervical myelopathy?
What are the major mechanisms?
a disorder in the cervical region of the spinal cord that disrupts or interrupts the normal transmission of neural signals
- direct compression of the spinal cord by bony or fibrocalcific tissues
- ischemia caused by compromise of the vascular supply to the cord
- repeated trauma secondary to normal flexion and extension of the neck
Which gender is more prone to stenosis? Which ethnicity?
Males < Females
Asian decent has higher prevalence
What are the signs and symptoms of cervical myelopathy?
- neck and upper extremity pain
- weakness and sensory impairments
- LMN signs at the level of lesion (weakness and hyporeflexia)
- UMN signs below the level of lesion(spasticity and hyperreflexia)
- paresthesia w/ weakness and wasting of the hands
- gait disorders
- bowel and bladder dysfunction
- loss of deep touch, vibration, and joint position sense
- lhermitte’s sign
What syndromes have been associated w/ cervical spondylotic myelopathy?
- Transverse syndrome (corticospinal, spinothalamic and dorsal column
- Motor System Syndrome (corticospinal and anterior horn)
- Mixed radicular and long tract syndrome
- partial brown-sequard syndrome
What information is conveyed from the corticospinal tract and what symptoms can occur from compression of the tract?
ipsilateral motor
lower extremity weakness
What information is conveyed from the posterior columns and what symptoms can occur from compression of the tract?
ipsilateral vibration/proprio
ataxia
What information is conveyed from the anterior foraminal tract and what symptoms can occur from compression of the tract?
ipsilateral motor
upper motor neuron signs
What information is conveyed from the lateral thalamic tract and what symptoms can occur from compression of the tract?
contralateral pain, temp, and touch
sensory changes
What stage of myelopathy involves hand and arm symptoms but doesn’t prevent performance of normal ADLs?
Mild
What stage of myelopathy involves considerable difficulty using arms and legs and effects performance of ADLs?
Moderate
What stage of myelopathy requires ambulatory aids and often confined to bed, chair, or home?
Severe
What are the clinical prediction rule signs for clinical diagnosis of cervical stenosis? How many need to be positive to rule in?
- gait deviation
- hoffman’s test
- inverted supinator sign
- babinski test
- age over 45
3 or more positive=rule in
What is considered absolute stenosis based of radiographic imaging?
spinal canal less than 10mm
What are the 3 main proposed treatment options for cervical stenosis?
Pharmacology (NSAID’s, opioid analgesics, muscle relaxant’s, corticosteroids, botulinum-A)
Surgery (anterior and posterior surgical techniques, laminectomy, laminoplasty)
Conservative Care (acupuncture, immobilization, bed rest, avoidance of high risk activities, manual therapy, exercise, traction)
True or False: Anterior approach surgery for cervical stenosis is a riskier procedure but has a higher success rate for long term success than posterior approach surgeries.
False, posterior approach has better long term success rates but has a lot of risks
True or False: There is no significant difference between long term outcomes for pts who had surgery vs. those who did conservative treatment for cervical stenosis
True, the long term was no different and so we recommend a 3 month trial of therapy before surgery is considered fully and only recommend surgery for severe cases
What factors negatively impact surgical success for cervical stenosis?
- age over 50
- duration of symptoms greater than 12 months
- involvement of multiple levels
- smoking history
What are “stingers” and “burners” in athletic injuries?
How do they relate to cervical stenosis?
neuropraxic injuries resulting in acute, short-lived episodes of extremity paresthesias or weakness
athletes with chronic stingers showed small central canals and over 50% had central stenosis
