What is Cervical Stenosis? | Jeffrey Cantor, MD

Hi, I'm Dr. Jeffrey Cantor from the Canter Spine Center at the Paley Institute and

what

I want to do today is go a little deeper into a problem that I see patients with regularly and that is one of the most common problems that we see and treat. and our patients and the general public don't understand it very well and that problem is called

cervical

stenosis

and we see patients regularly who are told they need surgery and sometimes it's an emergency and they come. I come in and say I don't really have any pain, I have these little tingles and I really don't know why I'm getting conflicting opinions.

A doctor says it's an emergency. The other doctor says wake up, wait until it gets worse and

what

I want to do is understand what

cervical

stenosis

is, why it is potentially a problem and it is important to understand that cervical stenosis is the most common reason for quadriplegia due to loss of the ability to walk and use your arms and legs. and other functions of the body and in people over 65, so it is a real problem and it is something that is really important to understand a little better, so if you are told that you have cervical stenosis, it is a good idea to look at this and Try to understand it, so what is the term stenosis?

It means that the body has pipes like tubes, blood vessels, the spinal canal, things travel through tubes inside the body and the term stenosis simply means when something starts to clog those tubes, so anything that enters these tubes . whether it is cholesterol or bone, it can compromise the inside of these channels and when it does, these channels can become blocked and that is the main reason for coronary artery disease, blood vessels, tubes start to get clogged and arthritis in the spine may also grow into the canals. where the nerves travel and cause a narrowing and that narrowing is called stenosis, so what does that look like?

This is an example of a spine, an MRI of a spine in the neck, in a side view, you see the bones stacking up. One on top of the other and inside the bones there is a canal, a tube that the nerves travel through, so if you look at that tube, what you can see is that there is a canal and that canal has a lot of space and the spinal cord is this passing structure. the center and in front and behind there is white and that white is fluid, it is space and this is an example here of another individual who instead of having a nice, clean line, all of this has grown towards the canal and instead of the spinal cord it has a lot of space, you can clearly see between here and here, it is severely compressed, that is, cervical stenosis and what it does is pinch the spinal cord that travels through that tube, so why is this important?

And many of you follow professional athletics and there is a lot of discussion today about concussions in athletes and we know that when you hit the brain, when you impact the brain, the brain is damaged, it actually goes away and if you hit the brain the time enough, you can lose enough brain where you have difficulties. Thinking like that, the NFL has spent billions of dollars investing in finding ways they can identify players who are developing brain injuries and alter that process. What's really important to know is that the spinal cord is basically an extension of the brain.

This is the base. of the skull the face is here and there is a hole at the base of the skull called the foramen magnum and the brain travels through that hole and below this point the brain becomes the spinal cord, it is the same structure, so above from the base of the skull this structure is called brain below the base of the skull it is called spinal cord it is the same thing it is not like a liver and a kidney it is an extension of the same structure so why is it so important? Well the brain is very delicate and when it hits it it damages the spinal cord it will do the same also notice that there is water there is space around the brain this white thing is water it is called spinal fluid in the skull the brain floats in water inside a space that doesn't actually when you hit it, it doesn't come into contact with the bones, that impact goes through the water and can actually damage the nerves without even physically touching the bone in the spinal canal.

There is also water and in the spinal canal you have a flexible group. of bones and that flexible group of bones moves around the nerves, so you have a tube, the nerves in the center and when you move your head, the bones move around the marrow, they don't come into contact with it when they start They come into contact with the spinal cord and when something comes into contact with the brain it damages it, when the brain and spinal cord are damaged they disappear, they literally turn into liquid and that is visible on an MRI, so they are can be quantified with a traditional MRI. scans brain damage and spinal cord damage and we'll discuss a little later some of the more advanced ways of quantifying it, so again the brain and spinal cord are the same extremely delicate structure that needs to be protected when not They are protected, they can be damaged, so why is it so important?

It's important because the body has a certain amount of tissue and in the nervous system situation, that tissue is born with a certain amount and that's all it normally has again. You're born with one hundred percent of your spinal cord that over time is going to degenerate and you're going to lose enough spinal cord, so at some point it can be difficult to do things like walk and the usual amount of time that takes. The time it takes is about 85 years, so we see a lot of people 85 and older who are really starting to stumble and have trouble walking and that can be natural wear and tear of the spinal cord where they really don't have enough left. to perform the functions. that they need it many people don't know what's happening, we'll describe why in a minute, but this process continues every day now if we collide with the spinal cord if we collide with it on a regular basis or really Big time, we can speed up This process a lot, so instead of having walking difficulties when we are 85, we will develop walking difficulties much younger, so the stenosis process that pinches the cord accelerates the process of damage to the court. from natural wear and tear and instead of having a normal lifespan of our nervous system, we can actually decrease that life expectancy where when we are 50 years old we start to have problems walking and when we are 60 years old we can lose our ability to walk completely, so , why does it go unnoticed?

The process is called neuroplasticity and what neuroplasticity is is the ability of the brain to adapt and the ability of the spinal cord to adapt to damage. Nova did a really nice overview and a really nice show a couple of years ago on neuroplasticity, if you want to dig a little deeper into that, the pbs tv show nova nova has a great overview of what it is, but in a very short description , the spinal cord is made of billions and billions of cells and, to make it simple, there are billions of cells and just in case, this area here is the part of the spinal cord that is responsible for, let's say , of moving the right arm when we develop stenosis and start running into this.

What happens is that those cells, as I mentioned earlier, disappear. they liquefy, they get damaged now, if they get damaged very quickly and we lose a lot of these cells, we can lose the ability to use our right arm, so if we really hit our spinal cord, we'll have an accident, a soccer injury or something So. I see football players get seriously injured, become quadriplegic, and then a couple of weeks later they get better. It is because they only damaged one area of ​​the spinal cord and have the ability to recover, so the brain will actually learn this function and transfer it. to other nerves, so now instead of using this part of the brain to use your arm, you are using this part of the brain, so that as long as the rate of damage does not exceed the rate of learning and recovery, I don't know that this is happening, it goes completely unnoticed and patients can go on for 50 or 60 years with cervical stenosis and then suddenly one day stop walking, so why does that happen?

As I mentioned, as long as the damage rate exceeds the recovery rate or the recovery rate exceeds the damage rate we can basically compensate for this, but when we get to the point where we have nothing left and lose more cells, We can no longer recover and that's when we start to lose. function and if you go back to the previous slide that's when we get to the point where we're out of gas so the spinal cord has lost enough tissue and it doesn't have anything to recover and then we start to stumble and it starts to fall and it starts to lose dexterity What are the symptoms of cervical stenosis?

How does the patient know they have it? And they can vary dramatically. Some patients arrive with very few symptoms. Some patients arrive in unbearable pain. It can range from extreme symptoms to no symptoms at all and interestingly the patient who has no symptoms could be worse off so this is a picture of a cadaver specimen of a cervical spine and if you look at it from the side the base of the skull and the bones in the neck and if we turn this around this is what we're seeing the bones in the front the bones in the front called the vertebral body is here the arch of bone that covers the spinal canal is back here and The spinal canal through which the spinal cord travels is here and it is also very important to see the amount of space between the bone and the spinal cord and that space is filled with water.

The spinal cord also has nerve roots that leave the cord. they work very differently this is a different graphic of basically the same structure it might be a little easier to understand the spinal cord itself in the center does not have any sensation very similar to the brain when you actually have the brain exposed during surgery the patient can be awake without pain and the spinal cord again is an extension of the brain so when you touch the spinal cord you can damage it without sensation so when we are when bone or stenosis is growing in the area and pinching the cord spinal, we can damage the cord with very little pain or discomfort as we lose cells we can begin to lose dexterity as we lose the ability of the wires within the cord to conduct signals we begin to notice changes in our ability to manipulate our hands to navigate when to walk and develop fine motor skills so we can see changes in dexterity and not feel pain.

The spinal cord also has branches that leave the spinal cord and these branches form what are called nerve roots, so at all levels nerves leave and enter the spinal cord. the arms and they go into the arms through what are called holes and they are these holes on the sides and what is really important to know is that these nerves are extremely sensitive so the pressure from pressing on the rope itself can cause damage without pain, but when a stricture forms. to one side and pinches the nerve roots, causing severe pain, can cause neck pain, can cause arm pain, can cause pain throughout the body, or all of the above, so the reason Symptoms are so variable in cervical stenosis it depends on where the bone is growing and where the stenosis is forming, it will cause pressure on the spinal cord, pressure on the nerve roots called foraminal stenosis or both pressure on the spinal cord, it is usually the most dangerous problem, but generally the least easy to notice and detect. understand how this cervical stenosis is formed, how we develop stenosis in the spinal canal in general and the basic process in most cases is related to arthritis and what happens is the body develops arthritis and this is an example of any joint , this could be your knuckle, this could be your knee, this could be the joints in your neck and what happens when we develop arthritis our bones expand the outside of the bone around the joint will start to grow now this is a finger it just gets bigger large, but in the spine, when the nerves pass through here, these bone spurs grow into the space and actually come into contact with the nerves, so arthritis is the most common process that lays down bone, that bone starts to invade spaces that are normally occupied by delicate nerves causing nerve damage, pain or pain, and loss of function.

Again, we showed this slide before, but this again is an example of nice, clean bones with a very large channel for the cord and fluid to pass through. in the front and back and here you can see the normal area of ​​the bones and you can see the bone spurs of arthritis forming and that formation in both directions is severely pinching the spinal cord so the underlying reason for the stenosis In the vast majority of cases it is arthritis and there are several different types of spondylosis.is the general term for arthritis there is something called ossification of the posterior longitudinal ligament there are several different types of arthritis but in general the deposition of tissue in the spinal canal due to arthritis is the most common source of this problem and this is a cross-sectional view looking at the spinal canal on end once again the vertebral body in the front the lot of space around the spinal cord the space around the cord with the cord in the center almost like a fried egg and here you can see a different patient where he has this big bone spur and a spinal cord instead of having a lot of room it's just squashed inside that spinal canal so here's a normal spine here's arthritis growing into the spinal canal causing severe spinal stenosis When does this become important, for example?

How many patients come and have no symptoms? They are called mild symptoms. Hey you need to have an emergency surgery someday you might not walk other people are told not to have surgery so it's been hard and a lot of patients can have strictures their whole life and never get in trouble you can have a pretty severe stenosis and never have a problem or you can have severe stenosis and one day you walk fine, the next day you sneeze and can't walk at all, so can we predict? There have been a lot of studies and a lot of ways of looking at the basic anatomy the structure the sizes and the spaces available trying to predict who is going to get in trouble and who isn't and what I'm going to do with this slide is go over the basics of what those parameters are and they're not very precise, they're kind of a guess, which really makes it difficult to determine this, so once again we have the same basic slide and we have from the front of the channel to the back of the channel the diameter of how much space there is. for the cord in the center and normally that diameter is 12 to 14 millimeters, the spinal cord itself is usually between eight and nine millimeters and there is a tube around the front and back that measures about half a millimeter on both sides, for The space needed for the cord and the sac it sits in is about 10 millimeters, so between 12 and 14 is normal, 10 is about the size at which the spinal canal is starting to get small, where the bone actually comes into contact with the marrow.

The textbook stenosis value is less than or equal to 10 millimeters, but in most patients it is not a problem, so in patients who do not have hypermobility or loose joints and some people do, but it is quite weird and that's a separate discussion, but in most patients who have a normal spine structure and a normal neck structure, if you follow these people for a long time, they don't get into trouble, so Although 10 millimeters is described as a threshold for what is called stenosis, it can sometimes cause some discomfort, but very rarely is this dangerous, there are cases where there may be variability where eight millimeters is approximately the size when we start to worry that one in three patients who have an eight-millimeter canal will start to enter. problems and interestingly, the patients who are already having problems when the diagnosis is made when that measurement is made are the ones who are most likely to have problems, so out of every three patients one will probably progress and about two will not, so The question is what is done?

If you have an eight millimeter canal and you don't have many symptoms, what did we do right in the past if you had no signs of umbilical cord damage? That's something that needs to be determined by someone who really understands this. If you don't have signs of what are called long-term follow-up signs, we will typically follow patients, re-examine them in a couple of months and maybe even after they go back to normal in a couple of years, but we really can't predict who it is. you're going to get in trouble it's kind of a guessing game one in three is going to be in trouble two and three no we don't really know who's going to have a problem so if you have symptoms and your eight millimeters will often advise you to do it something about it to open it up and fix it surgically and if you don't have symptoms, we'll generally recommend at that point in the process above looking at it six millimeters or less is really a problem, it's dangerous, there's so much pressure. in the cord that is very likely to cause problems at a rate that could be dangerous and many patients with six millimeters, even those who don't have problems, will have problems, so with six millimeters we generally recommend some type of treatment. so these are basic numbers, they are kind of a general assumption of where you will be now if patients have symptoms if you have progressive difficulty with dexterity progressive difficulty with balance if you notice that when you are going up steps you have more and more trouble finding your way when you walk and you change direction you feel like you are going to fall if you have numbness in your hands when you move your neck if you start to notice jerks and tingling in your arms or if you are in significant pain, these parameters are a little less important because once you have symptoms really significant, surgery is more necessary now, it is also important to know that patients who have cervical stenosis causing damage to the cord called myelopathy, surgical solutions work better than patients treated without surgery, so if you have cervical stenosis and are getting worse or have a major problem on an exam done by someone who really knows how to see it. problem, if you treat it, you will probably do much better than not treating it in the long run.

Additionally, it is important to know that the longer you wait and the worse the problem, the more dangerous the treatment will be for patients who have a relatively healthy cord that is damaged early. If the canal is opened, they do better than if they wait until they actually have problems because of the potential problems associated with the surgery itself and we're going to discuss that in a few minutes, so these are two examples of patients with cervical problems. Stenosis and interestingly this one looks pretty severe and this one looks pretty mild. This individual has no symptoms other than some mild tingling in the fingers.

This is an elite athlete that every time she moves her neck, every time she jumps into a pool, every time she does it. doing something active you feel exquisite tingling and numbness in your arms you almost feel like you are getting electric shocks in your arms and legs and you are slowly but progressively losing strength in your arms and legs so this is a patient who is much older, around 60 years old. a patient in their 50s this person is much more symptomatic and if you look at this one you would expect this patient to have much more serious problems and that goes back to the rate of loss versus the rate of recovery and as I mentioned earlier The disease of the spinal cord causes damage to the cord and causes the cord to liquefy.

This is white spinal fluid. The gray is the actual nerve cells and when this marrow is damaged it turns into water. The water is white and if you look at these areas here you can. Now I see white spots inside the spinal cord, that's visible central damage, that's enough, the actual spinal cord has been damaged, gone and liquefied, where you could actually see it, that's called myelomalacia. Myelomalacia is a bad sign, but what it also shows is that this process is very slow. This is someone who is losing cells, and as he loses them, he recovers at a rate that doesn't allow this to be noticeable, so you are developing a core disease, but you don't know it.

This is quite significant and I would do it. They say that most surgeons would look at a neck like that, if it's a healthy patient, they would recommend fixing it because it's someone who can fall off the edge, it's someone who can walk around without problems and look up to see a plane and fall . the ground and not move again, so this is one of those patients that someone says, "Hey, if you get in a car accident, you can be paralyzed; it's not that common, but what is common is that a once you get to the point where there is visible damage to the cord. you're likely to make progress if you're active if you're athletic if you're someone who likes to ride a bike if you like to ski if you like to do things and you have a spinal canal that looks like this, that's potentially dangerous What's happening to this patient? is that, although the stenosis is mild, what is also interesting is that if you measure this spinal canal, it is about 10 millimeters, maybe a little less, so it does not meet the criteria for severe stenosis, this individual is mobile Of bones. where the bones move against each other and actually hit the marrow and when they do that it's like having a concussion, it's like getting hit in the head and when that happens it hits the marrow. and causing significant damage, so the difference between this person and this one is that, although it seems less severe, the impact is causing more rapid degeneration of the spinal cord nerves and the degeneration is exceeding the nerves' ability to recover, so even though they may have less damage here, the body cannot recover quickly enough, so it is more symptomatic, so also what is important here is the ability to determine whether or not this individual has a related problem with the stenosis now in the past if you just look at the measurements the guessing measurements that we looked at before this is obviously a problem and this is not new this is something exciting and this is a very, very different way of looking at the spinal cord and a lot of The research and a lot of the technology that is leading to this new technique called diffusion imaging actually comes from the NFL and it comes from the need to look at brains and determine how much damage there is.

So what is this? This is called diffusion MRI and this is. a standard MRI and what this looks at is here is the brain and again the spinal cord and this image the spinal cord looks like a gray tube you can't see the nerves you can't see how many nerves there are you can't see if there is any damage to the nerves , you can see the spinal cord as a kind of shadow, this is diffusion image and what this shows, this structure here is this and what it shows are all these fibers, these are actually the nerves that this shows.

We have a healthy spinal cord, so what we are seeing here is a very open spinal canal that the spinal nerves travel through and what it looks like when they are normal. What fusion imaging does is a fast MRI that can actually track water. the molecules that flow through the neurons now the neurons are like hoses, they are pipes and MRI can detect the direction of the water molecules, so when the nerves are not damaged, it will flow through the nerves in a nice straight line like a horse's mane when the nerves start to get damaged it's going to start to fray and you're going to start to lose that clean look this is what the diffusion images look like on the end so side view this is end in sight and when we look at the nerves, a normal spinal cord will be completely red, which shows that all the water, all the tubes, all the hoses, they are flowing water in the same direction on the outside, you see a little bit of yellow and green. a little bit of green turbulence is actually not normal flow and that is actually getting to the area around the cord where the spinal fluid is, but inside the spinal cord you should see red or red and yellow once you start seeing in this particular green and blue color sequence that's where the spinal cord is damaged and again this is the long term view this is the view where it's cut in half looking at it from the end so this is an example of a normal spinal cord and This is what a spinal cord looks like when it's damaged, so we can look at your umbilical cord and say, "hey, you have some stenosis, but your cord is pretty healthy." Instead of you starting to have problems, we can know quantitatively if you're starting to get to the point. where this could be dangerous so two more patients two more examples this is an individual with relatively severe stenosis he was sent here for surgery but he does not have any symptoms this is the same patient that we observed before he really does not have visibly severe stenosis but he has many symptoms, for which if we look at their diffusion MRIs, this initial patient with what was thought to be significant stenosis has a healthy spinal cord, this person doesn't need surgery, probably doesn't even need to be monitored much. frequently the marrow is healthy even though the bone is growing into the canal it is not causing significant damage this is the patient was a bit confusing where there are many symptoms but no severe pressure but if we look at the actual nerves themselves, the What we can see is severe damage, the cord instead of being good and healthy is frayed, it is called isotropy and that shows that the spinal nerves, instead of the fluid flowing in one direction, escape, as if you pass the hose. times on the roadfrom the outset how cervical stenosis is treated and in patients who get to the point where it is considered necessary to fix it, clearly understand what is happening and clearly understand the options, there is a sequence of how this disease has been treated and Let's go through by sort of a linear progression of how cervical stenosis has been treated, some of the older techniques, some of the newer technologies and some of the newer techniques, and initially the way cervical stenosis was treated was called laminectomy and A laminectomy simply means removing the covering, so if we look at this from the side and what we see is that the cord is pinched from the bottom up, something has to be done to open that channel and with traditional techniques, or we go from the side At the front of the neck we take out the bones, remove them, put in a long spacer or several spacers and do what is called fusion, so we take the pressure off the cord from the front and essentially open up the canal.

By removing all of this, the most solution The old one goes from the back of the neck and removes the covers and these covers are called lamina and the early operation is called laminectomy, so if we rotate this we see the same thing from the front of the neck we would remove the bone spurs and open this canal and in the back of the neck we would basically cut this arch and basically just open it wide open and it seemed like a good idea, but laminectomy is associated with a significant number of problems and one of the problems associated with laminectomy is when we perform the procedure and the head is upright before the operation in about one in three patients. you will end up with your head falling off and once that happens it really can't be fixed and it is a big problem, it is certainly difficult to spend the rest of your life looking at your feet, so this is called post laminectomy kyphosis and there is a reason for With traditional techniques and traditional technologies, it is a little difficult to prevent this, so why does this happen?

Why do we have post-laminectomy kyphosis? Why does the head droop after a procedure? And the answer is in the structure that holds the head up if you touch the back of your head there is a lump and if you slide down there is a second lump and those two lumps connect to a ligament a cable here is the lump in the back of your head here is the attachment to what is called the c7 spinous process this is called the nuchal ligament and that holds the head upright it is attached to the lamina the lamina that we remove in a laminectomy removes this wire and when that wire is removed the head drops and it happens quite frequently where we have had to develop as surgeons I had to develop techniques to reconstruct what was removed, so if you look at a bridge and you put the spine on its side, the tip of c7 is here and the back of the skull is here and the cable goes from one stud to the other if you remove any of these, the bridge will end up in the water, which again is the same thing that happens when you do a laminectomy and you remove these fittings from these cables.

This is the result of what has been done to remedy this problem. We use what are called fusions, so when we take out the structure we rebuild it and go from the front of the neck, take out the bones and replace them with long bone struts or individual small bones and then put a plate in and clamp. the bones together with plates and screws and allows the structure that we removed to grow back, it doesn't grow back normal, it grows back in one solid piece, so each individual bone that was moved before is no longer moving.

The challenge with fusions and the problem with fusion is We take all the mobility that normally was in this area and we shift it up and down so that the movement that is lost in this area now has to be absorbed by this joint and this joint and were not designed to withstand as much stress when We do fusions, we transfer stress up and down and that increases the rate of arthritis in the adjacent joints if stenosis normally forms and we increase the stress on the adjacent joints when doing a fusion, which goes What happens is that you will increase the rate of arthritis in the joints above and below the fusion and you will have a recurrence of the same problem, so fusions, especially when they are more than two levels, lead to an increase in tensions and usually lead to additional fusions, so when you merge in one area you will probably merge the next and the next and the next, at some point you will run out of space and then we will be in a bad situation, so although fusions are very effective Operations to remove stenosis tend to lead to additional surgeries, limited mobility, and possible problems down the line, and this is another example of an individual with a fusion and severe stenosis, even life-threatening stenosis at the next level.

The other options for mergers. is to do the fusion from the back of the neck. This is a large incision almost 10 inches and because we took out the ligament we have to replace it and we replaced it with screws and rods. Now again it is a very effective way to treat stenosis, but it is a very ineffective way to maintain function, mobility and lifestyle, so most patients who have stenosis have numbness and tingling and maybe some problems walking when we perform this operation, we can often help them a lot, but if you ask them a year later, are they?

Happy with the operation, many of them would say they wish they had never had it done because the mobility limitation also causes significant and constant neck pain and will never get the muscles that normally move the head back where they are supposed to be back. There is a lot of tension, a lot of pain and a lot of discomfort after these operations. This is an operation I used to use for teaching. I do it very rarely due to the fact that most patients who have had this operation do not actually do it. Like, so there's a new technology that's really changed things and the new technology is called ultrasound and this is an older tool that we use to cut bone, it's similar to a dremel, it's sharp, it spins, it tears and it cuts. very effectively the bone, but when you put it next to something soft it is quite dangerous this is an ultrasonic tool it uses vibration it is more powerful than the cutting tool it will go through the plastic and the bone much faster than a traditional tool but since it is not sharp and because it doesn't It doesn't spin, it's very safe around delicate structures, you can barely pop the balloon if you try this, so it can be used in direct contact with nerves, you can actually physically touch a nerve with this tool if you know how to do it, it's not like that.

It's easy to use and can work on very small incisions, so why is it so important? It allows us to use procedures that don't damage normal tissues, so through an incision that size, compared to a 10-inch incision, we can take all the pressure off the nerves without interfering with any of the normal structures, so that the cables that hold the head up are not interfered with and because they are not interfered with we do not have to reconstruct them using ultrasound and using techniques where we work under the ligaments and preserve their insertions and preserve their normal mechanics and now we are reinforcing those ligaments with different suturing techniques, we can fix the neck without causing additional damage, that is important because this is a patient before surgery and after surgery and apart from the fact that you can see that the spinal canal is small here and much larger here, which means the marrow has a lot of room here and no room here, this looks pretty much the same as that, so essentially what this has done is just plastically remodel the bones from the inside out saving all ligaments without the need for screws without the need for rods without the need for fusions without stress transfers so the likelihood of needing additional surgery is much lower: about one percent for about 15 years versus almost 15 to 30 percent for year with more than a three level fusion, so these operations preserve function, preserve mobility and this is something that can be used to intervene a little earlier because it offers a better lifestyle option, so let's wait until can't walk with devices to repair your stenosis that used to be unreasonable in the past is now less reasonable because we have better treatment options once again.

This is a comparison between the typical anterior fusion where the structure is removed and reconstructed with plates or anterior plates and screws in the front of the neck the probability of stenosis at the adjacent level is quite high. This is a traditional operation that is performed from the back of the neck or posterior fusion where the ligaments were removed. These screws and rods replace a ligament to hold the head upright and this. is a newer technique in which decompression, pressure removed from the spinal cord, can be performed in and under the ligaments without interfering with their normal attachments and therefore do not need to be reconstructed with screws, rods and fusions , a much better option now.

It is important to understand that these are a type of stricture. There are many different situations. Operations must be mixed and matched. In other words, sometimes we will do plastic surgery with a single-level fusion versus a multi-level fusion, so we will decide which patient you have. what their individual situation is and we do an operation that saves everything that works for them and what is good and we replace it, we repair what is not good instead of essentially fixing everything and then just rebuilding it with metal, so I hope this has been useful. I hope you're a little bit better informed about cervical stenosis, what it is, what some of the treatments are, it was a bit of a deep diet, but there's still a lot more detail, patients have stenosis with associated deformity where their head may not be in correct position things like that which makes it a little more complicated this is not a one size fits all solution this is just a brief overview of what stenosis is, why it can be potentially dangerous and problematic and whether you or should not consider the surgery if you want someone to take a look at it if you want us to talk to you about this, feel free to give us a call and we hope this has been something helpful for you.

Thanks so much for looking.