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Cervical Spinal Stenosis | Q&A with Dr. Brian J. Neuman

[MUSIC] Cervical spinal stenosis is
narrowing of the cervical spinal canal, and that causes compression
either on the spinal cord, which would cause a disorder
called myelopathy, or compression on the nerve roots. [MUSIC] Problems with radiculopathy or
compression of the nerve root will cause symptoms such as pain that
radiates down the arm into the hand and also numbness and tingling that
can occur in the hand as well. [MUSIC] Cervical spinal stenosis is caused
by multiple factors into the neck. And it's compression on the nerve
from the ligaments posteriorly that causes compression
on the spinal cord. Anteriorly, or in the front of the
neck, it's from the disk herniation that causes compression
on the spinal cord.

And then the joints that we have in
our neck can get osteophytes that grow that causes compression out
laterally onto the spinal cord, and onto the nerve roots. [MUSIC] The best way to diagnose
them is with imaging, which would be with an MRI. If a patient is unable to have an
MRI then the next best option would be a CT myelogram where they
inject dye into spinal canal and able to evaluate that on a CT scan. [MUSIC] A compression on the spinal cord,
which causes myelopathy would give you symptoms such as
imbalance when walking, trouble to find motor skills and
hand writing. [MUSIC] Non-surgical options
are physical therapy, which can help decrease some of
the inflammation around the nerves. But the best non-surgical treatment
would be anti-inflammatory medications or trial of injections. And those injects would decrease the
inflammation around the nerve root which would decrease
the symptoms that are occurring. [MUSIC] Firstly, it could be treated
anteriorly or in the front of the neck by doing a decompression
with removal of any object or structure that is causing
oppression on to the spinal cord. Which would be a discectomy or
moving the disk or corpectomy removing any portion of arterial
body that is causing compression.

Now also it could be treated
posteriorly, which is from the back of the neck, and that would be by
removing the posterior structures that is causing compression on to
the nerve roots or the spinal cord. Be it the facet joints or the ligaments that
are causing compression. Also it can be treated with
a procedure called a laminoplasty. It's also treated from
a posterior approach, meaning the back of the neck, but
this procedure opens the canal but does not cause a fusion so
you don't lose motion of your neck. [MUSIC] Physical therapy after
surgery is not always needed. The patients that I operate on, I
usually keep them out of therapy for the first six weeks and
see how they do. After that period, I let them go
enjoy life and see how they do.

And if they do feel that they
have decreased range of motion, stiffness of the neck,
or any neck pain, then I get them into therapy at that
time to help with those symptoms. [MUSIC] Here at John's Hopkins we use
a multidisciplinary approach to treat them. And that is mostly with
an non-operative treatment. And that would be working with
physical therapist to work for a structure program that is
individualized for each patient. We also work very closely with the
pain managements team to work with oral medications that
the patient should be on, and also with a trial of injections to
see if it helps reduce her symptoms to avoid any kind of surgery. [MUSIC] Advances had been made recently
in the last five to 10 years in treatment of spinal canal
stenosis is doing surgeries that preserve motion of the neck. And those surgeries entail
instead of doing a fusion, doing a disk replacement from
the front of the neck, or if needed doing a laminoplasty
from the back of the neck.

And both of those procedures
preserved motion of the neck and would not warrant
a fusion of those levels. [MUSIC].

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