Back Surgery for Cervical Spinal Stenosis

Cervical spinal stenosis is a condition where the spaces in the spinal canal in the neck have become obstructed or narrowed leading to pressure being placed on the spinal nerves and the spinal cord. Although cervical spinal stenosis is fairly common, it is usually the lumbar spine that is most frequently associated with stenosis and for which patients undergo back surgery. The thoracic spine can also become stenotic but this is considerably less frequently diagnosed. Patients may have evidence of stenosis at a number of vertebral levels and require accurate testing to ensure the correct identification of the nerve(s) producing the symptoms of neck and/or back pain. This is particularly true in cases where the degeneration is due to age-related wear and tear rather than acute injury. Compression of blood vessels, and problems with the intervertebral discs, spinal ligaments, and other important tissues and structures can also be both the cause and effect of cervical spinal stenosis, particularly as the neck contains so many important structures and tissues competing for space.

Cervical Spinal Surgery – A Delicate Procedure

The presence of the thyroid gland, the trachea, oesophagus, and major veins and arteries makes the neck a complex site on which to conduct surgery. Several nerves in the area are responsible for innervating a multitude of different tissues and surgery risks causing nerve trauma leading to problems with the voice, breathing, swallowing, and other functions. Conversely, cervical spinal stenosis that remains unaddressed may cause permanent nerve damage in itself, with a delicate balance struck between conservative management and urgent intervention for patients. Cervical spinal stenosis with myelopathy is usually only treatable with surgical decompression although radiculopathy often responds well to conservative treatments such as NSAIDs, activity modification, and specific exercises for pinched neck nerves. Myelopathy often progresses slowly with mild symptoms initially and then a sudden increase in difficulties with coordination and mobility. Surgery is then, for almost all patients, the only way in which symptoms might be relieved.

Cervical Spinal Stenosis Surgery Types

Back surgery for cervical spinal stenosis may take the form of a relatively minor microforaminotomy, or a more extensive laminectomy, discectomy, and spinal fusion procedure. Techniques to achieve substantial decompression of the spine with minimal access and tissue trauma have improved considerably over recent years, with many patients able to undergo an operation in a clinic setting and return home on the same day. More traditional, open back surgery procedures often take a lot longer, require general anaesthetic, and involve a few days in the hospital for monitoring and initial rehabilitation. The usual surgical risks apply in all cases, with infection (both deep and shallow), thrombophlebitis, nerve and spinal cord trauma, and blood loss possible. Patients may also suffer from respiratory or cardiovascular complications, particularly if having a general anaesthetic where predisposing medical conditions are present. Failed back surgery syndrome is also a possibility, and may be due to scar tissue formation, accidental trauma during the procedure itself, or possible misdiagnosis and operation at the incorrect vertebral level.

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