Cervical Stenosis: Difference between revisions

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== Characteristics/Clinical Presentation  ==
== Characteristics/Clinical Presentation  ==


Cervical stenosis does not necessarily cause symptoms, but if symptoms are present they will mainly be caused by cervical radiculopathy or myelopathy. <br>  
Cervical stenosis does not necessarily cause symptoms, but if symptoms are present they will mainly be caused by [http://www.physio-pedia.com/index.php?title=Cervical_Radiculopathy cervical radiculopathy] or [http://www.physio-pedia.com/index.php?title=Cervical_Myelopathy myelopathy]. <br>  


The symptoms are:<ref name="1">North Amercian Spine Society, Cervical Stenosis, http://www.spine.org/Documents/cervical_stenosis_2006.pdf (accesed 22 november 2011</ref><ref name="2">Williams S.K. et al, Concomitant Cervical and Lumbar Stenosis: Strategies for Treatment and Outcomes, Semin Spine Surg, 2007 Sep, volume 19 issue 3: 165-176. (Level of Evidence 2A)</ref><ref name="3">Countee R.W. et al, Congenital Stenosis of the Cervical Spine: Diagnosis and Management , J Natl Med Assoc, 1979 March, Volume 71, Issue 3, 257-264 (Level of Evidence 2B)</ref>  
The symptoms are:<ref name="1">North Amercian Spine Society, Cervical Stenosis, http://www.spine.org/Documents/cervical_stenosis_2006.pdf (accesed 22 november 2011</ref><ref name="2">Williams S.K. et al, Concomitant Cervical and Lumbar Stenosis: Strategies for Treatment and Outcomes, Semin Spine Surg, 2007 Sep, volume 19 issue 3: 165-176. (Level of Evidence 2A)</ref><ref name="3">Countee R.W. et al, Congenital Stenosis of the Cervical Spine: Diagnosis and Management , J Natl Med Assoc, 1979 March, Volume 71, Issue 3, 257-264 (Level of Evidence 2B)</ref>  
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== Diagnostic Procedures  ==
== Diagnostic Procedures  ==


Physical examination: <ref name="1" /><ref name="2" /><ref name="3" /><ref name="4">Santhosh A. et al., Spinal stenosis: history and physical examination, Phys Med Rehabil Clin N Am , 2003, 14,</ref><br>
Physical examination: <ref name="1" /><ref name="2" /><ref name="3" /><ref name="4">Santhosh A. et al., Spinal stenosis: history and physical examination, Phys Med Rehabil Clin N Am , 2003, 14,</ref><br>  


*Increased reflexes in the knee and ankle, this is called a hyperreflexia, it’s sometimes found with depressed reflexes in the arm  
*Increased reflexes in the knee and ankle, this is called a hyperreflexia, it’s sometimes found with depressed reflexes in the arm  
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== Medical Management <br>  ==
== Medical Management <br>  ==


add text here <br>  
In cases with increasing weakness, pain or instability to walk, then is surgical management of[http://www.physio-pedia.com/index.php/Surgical_and_Post-Operative_Management_of_Cervical_Spine_Stenosis cervical spine stenosis][http://www.physio-pedia.com/index.php/Surgical_and_Post%E2%80%90Operative_Management_of_Cervical_Spine_Stenosis ]recommended.&nbsp;<ref name="5">Fassett D. R. et al, Asymptomatic Cervical Stenosis: To Operate or Not?, Semin Spine Surg, 2007 March, Volume 19, Issue 1, 47-50 (Level of Evidence 2A)</ref><ref name="6">Kadanka Z. et al, Approaches to Spondylotic Cervical Myelopathy Conservative Versus Surgical Results in a 3-year Follow-up Study, SPINE, 2002, Volume 27, Number 20, 2205-2211 (Level of Evidence 1B)</ref>
 
Surgical options include anterior decompression and fusion, where the disc and bone material are causing spinal cord compression is removed from the front and the spine is stabilized. The stabilizing
 
of the spine, which is called fusion, places an implant between the two cervical segments to support the spine and compensate for the bone and the disc that has been removed. <ref name="1" /><ref name="2" /><ref name="3" /><ref name="7">Boni M. et al, The Cervical Stenosis Syndrome with a Review of 83 Patients Treated by Operation, International Orthopaedics; 1982, Volume 6, Issue 3 , 185-195 (Level of Evidence 2B)</ref><ref name="8">Caron T. H. et al , Combined (Tandem) Lumbar and Cervical Stenosis, Semin Spine Surg, 2007 Sep, Volume 19 Issue 3, 44-46 (Level of Evidence 2A)</ref><ref name="9">Engle C.A. et al, CERVICAL STENOSIS IN THE ATHLETE, Operative Techniques in Orthopaedics; 1995 Jul , Volume 5, Issue 3, 218-222 (Level of Evidence 2A)</ref>
 
Another surgical option is laminectomy. This is a procedure where the bone and ligaments that are pressing against the spinal cord are being removed. In this treatment the surgeon might add also a fusion to stabilize the spine. <ref name="1" /><ref name="2" /><ref name="3" /><ref name="7" /><ref name="8" /><ref name="9" /><br>After the surgery, the patient has to remain in the hospital for several days. [http://www.physio-pedia.com/index.php/Surgical_and_Post-Operative_Management_of_Cervical_Spine_Stenosis A postoperative rehabilitation program] may be given, so that the patient can return to his activities and his normal life. <br>  


== Physical Therapy Management <br>  ==
== Physical Therapy Management <br>  ==

Revision as of 13:01, 16 January 2012

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Characteristics/Clinical Presentation[edit | edit source]

Cervical stenosis does not necessarily cause symptoms, but if symptoms are present they will mainly be caused by cervical radiculopathy or myelopathy.

The symptoms are:Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

  • Pain in neck or arms
  • Arm and leg dysfunction
  • Weakness, stiffness or clumsiness in the hands
  • Leg weakness
  • Difficulty walking
  • Frequent falling
  • The need to use a cane or walker
  • Urinary urgency which may result in later cases in bladder and bowel incontinence
  • Diminished proprioception


The progression of the symptoms may also vary:

  • A slow and steady decline
  • Progression to a certain point and stabilizing
  • Rapidly declining


Differential Diagnosis[edit | edit source]

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Diagnostic Procedures[edit | edit source]

Physical examination: Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

  • Increased reflexes in the knee and ankle, this is called a hyperreflexia, it’s sometimes found with depressed reflexes in the arm
  • Changes in the gait such as clumsiness or loss of balance
  • Loss of sensitivity in the hand/or feet
  • Rapid foot beating that is triggered by turning the ankle upward.
  • Babinski’s sign
  • Hoffman’s sign

X- rays of the cervical spine doesn’t provide enough information to confirm cervical stenosis, but can be used to rule out other conditions. Cervical stenosis can occur at one level or multiple levels of the spine, therefore is an MRI useful for looking at several levels at one time. It’s also useful to use MRI images because they are very detailed and show the tight spinal canal and pinching of the spinal cord. But a CT scan can give better information about the bony invasion of the canal and can be combined with myelography. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

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Examination[edit | edit source]

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Medical Management
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In cases with increasing weakness, pain or instability to walk, then is surgical management ofcervical spine stenosis[1]recommended. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

Surgical options include anterior decompression and fusion, where the disc and bone material are causing spinal cord compression is removed from the front and the spine is stabilized. The stabilizing

of the spine, which is called fusion, places an implant between the two cervical segments to support the spine and compensate for the bone and the disc that has been removed. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

Another surgical option is laminectomy. This is a procedure where the bone and ligaments that are pressing against the spinal cord are being removed. In this treatment the surgeon might add also a fusion to stabilize the spine. Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
After the surgery, the patient has to remain in the hospital for several days. A postoperative rehabilitation program may be given, so that the patient can return to his activities and his normal life.

Physical Therapy Management
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