Cervical Spinal Stenosis
By Dr. Donald Liebell
The term, stenosis simply means a narrowing or constriction of a passageway or vessel. When it comes to the neck or back, Stenosis refers to a narrowing of either:
(1) The openings where the spinal cord branches off out to the body. These are called inter-vertebral foramina or neural foramina. These are the nerve passageways formed in between the interlocking vertebrae the nerve roots exist in these canals.
(2) The spinal canal, which houses and protects the spinal cord. The spinal canal is formed by the interlocking bones of the spine (vertebrae). Picture a stack of doughnuts one on top of another. The spinal canal is formed by the vertebra stacked in a similar manner
Cervical spinal Stenosis can cause compression (squeezing) of the spinal cord and/or the nerve roots. This can result in various problems such as: pain, stiffness, numbness in the neck, arms and legs and balance problems.
Cervical spinal Stenosis can affect your entire body since it interferes with normal nerve conduction or flow back and forth to the entire body.
Cervical spinal Stenosis can cause loss of function in areas far away from the neck. It could even cause loss of bowel or bladder control if the spinal cord is damaged enough. Notice in the pictures below the round canal on the left (normal) and the narrowed canal in the other two.
What causes cervical spinal stenosis?
Degenerative changes or breakdown of the vertebrae and discs can be a major cause. Extra growth of bone causes a narrowing of the spinal canal or the openings (intervertebral foramina). It can be seen more commonly in people older than age 50.
Bulging or herniated discs can create Stenosis too. If the cushioning spinal disc bulges or herniates, the disc material protrudes out into the space of the spinal canal or the nerve roots. There is a difference between Stenosis caused by bone, and Stenosis caused by discs. Bony Stenosis is a physical loss of space for the nerves to live. Disc-based Stenosis is a narrowing of the nerve space by an “invading” tissue.
The “hidden” type of cervical Stenosis
In my colleagues and my experience, there is a type of cervical spinal Stenosis that is virtually ignored. The scary part to me is that it’s possibly the most important and the most common…
Upper Cervical Stenosis
This is narrowing of the spinal canal at the top of the neck (upper cervical spine), caused by very small misalignments of the first vertebra (the Atlas bone), relative to the skull and the spine below it. This type of Stenosis is the primary focus of my practice. Stenosis can interfere with nerve function and make you feel miserable.
Does cervical spinal Stenosis always cause neck pain and other symptoms?
No. In fact, one can have severe stenosis and have no pain at all. We can’t assume that just because a nerve pathway is narrowed that nerve function is affected. In my practice I can recall dozens of cases of severe Stenosis—confirmed by x-ray and MRI… that were able to be relieved of their pain by non-surgical and drug-free means. The bony Stenosis was still present, but the pain was gone. That means that there are other causes of pain beyond what sometimes LOOKS like the cause. Cervical spinal Stenosis can take years or even decades to become severe enough to compress the spinal cord or nerve roots, and finally result in symptoms.
How is cervical spinal stenosis diagnosed?
Health history and physical examination are the starting point. X-rays, MRI and CT scans may be used to hone in on the diagnosis. Sometimes blood tests may be done to rule out other conditions including ALS (Lou Gehrig’s Disease), Multiple Sclerosis (MS), nutritional deficiencies, etc.
How is it treated?
Conventional medical treatment typically involves pain medication prescribed by a physician. Others are given physical therapy exercises. Surgery may be done to try to widen the narrowed space. While I appreciate the role of such common approaches, I do not use them. In my practice I treat Stenosis with various non-surgical and drug-free procedures.
This of course, does not mean that I accept everyone as a patient.
Let's face it: nobody WANTS surgery, but some people simply need it. Even though I’ve had great success helping people with spinal stenosis; some get referred to orthopedic or neurological surgeons. I don’t treat people unless I have evidence that my procedures might help. Spinal Stenosis can be a very tricky condition. I have successfully treated people who were assured that the Stenosis was the cause of their pain…but it was not.
Remember: one can have Stenosis without pain… and one can have no Stenosis and have lots of pain.
-Dr. Donald Liebell
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