Cervical Spinal Stenosis Treatment Options

For mild cases of cervical stenosis without significant symptoms non-surgical, conservative management may be recommended. This is especially true when there is no evidence of compression of the spinal cord itself. Treatment is aimed at decreasing inflammation, managing pain, and improving physical function.

Conservative management includes:

1. Pain and anti-inflammatory medicines (NSAIDs) and acetaminophen, and muscle relaxers. Dr. Singh may prescribe pain relievers to manage pain and inflammation.
2. Rest with a temporary neck collar or brace to provide support.
3. Activity modification involves avoiding activities that worsen symptoms, maintaining good posture.
4. Physical therapy including exercises, stretching, and strengthening routines can help improve posture, neck strength, and flexibility. Physical therapy may also include modalities such as heat or cold therapy, ultrasound, or electrical stimulation.
5. Spinal steroid injections may be recommended when there nerve root compression and severe pain. These injections help to reduce pain, inflammation and swelling.

If a patient does find relief with a trial of non-surgical treatment, symptoms worsen or the condition is severe, Dr. Singh may recommend surgery as a solution for cervical spinal stenosis.

There are two primary types of surgery to treat cervical spinal stenosis, depending on whether the patient has multiple levels of narrowing: A Cervical Disc Replacement or a posterior microsurgical cervical laminoplasty. The goal of surgery is to increases the canal space for the spinal cord and nerves to alleviate compression.

Anterior Cervical Disc Replacement

Artificial cervical disk replacement has become a viable surgical alternative to anterior cervical discectomy and fusion (ACDF) in almost all patients. In artificial cervical disc replacement, the damaged cervical disc is removed and replaced with an artificial disk made up of titanium and plastic (like a total knee or hip replacement). Compared to a cervical fusion (which involves plates and screws), the disc replacement maintains motion leading to less wear and tear on the vertebra above and below the surgery site. Patients are discharged the same day without the need for a neck collar.

Microsurgical Cervical Laminoplasty

Microsurgical cervical laminoplasty is a minimally invasive technique for decompression of cervical nerves. The aim is to preserve the stability and motion of the spine while decompressing the spinal cord and nerves.

By using operating microscopes in spinal surgery, Dr. Singh works through a smaller incision and with greater safety. First, Dr. Singh makes a small incision on the back of the neck and while preserving the muscle and soft tissues around the spine he opens the lamina (the back portion of the vertebral arch) and the small, attached muscles around it to gain access to the nerves that travel within the spinal canal. Then, he uses specialized equipment to remove bony spurs, and any other structures that are pushing on the nerves. Then Dr. Singh inserts a small plate which he designed to hold the lamina open to create space for the spinal cord and nerve roots.

Microsurgical cervical laminoplasty offers several advantages over traditional laminectomy procedures. The use of a microscope or magnifying loupes allows for more precise visualization of the surgical field, minimizing damage to surrounding tissues. It also reduces the need for extensive muscle dissection, resulting in potentially faster recovery and decreased postoperative pain. Most importantly, there is no need for a fusion using screws and rods.