Zervikale Spinalkanalstenose

Cervical spinal canal stenosis means the main tunnel in the neck that carries the spinal cord has become too narrow, so the cord and nearby nerves can be squeezed. This can cause neck pain, hand clumsiness, balance problems, and in more advanced cases, weakness and bladder/bowel changes.​

1) What is this condition?

  • Age‑related wear, disc bulges, bone spurs, and thickened ligaments slowly narrow the canal in the neck.​

  • The narrowed space can compress the spinal cord (cervical myelopathy) and/or the nerve roots (radiculopathy), leading to symptoms in the arms and legs.​

2) How serious is it?

  • Mild narrowing may cause little or no symptoms and can be monitored.​

  • Progressive stenosis that compresses the cord can lead to permanent problems with walking, hand function, and bladder/bowel control if not treated.​

3) Non‑surgical treatments

  • Activity and posture changes: avoiding heavy lifting, violent neck motions, and prolonged extension; optimizing workstation ergonomics.​

  • Medicines: anti‑inflammatory drugs and pain relievers; sometimes short courses of nerve‑pain medicines.​

  • Physical therapy: gentle range‑of‑motion, postural training, balance work, and strengthening under guidance; often used in mild cases.​

  • Short‑term collar use, traction, or epidural injections may be considered in selected patients mainly for pain relief, not as a cure.​

4) Possible surgery

  • Front‑of‑neck (anterior) operations:

    • ACDF (anterior cervical discectomy and fusion) or disc replacement to remove disc/osteophytes and then fuse or replace the disc.​

  • Back‑of‑neck (posterior) operations:

    • Laminectomy or laminoplasty (with or without fusion) to open the canal from behind over several levels.​

5) Goals of surgery vs non‑surgical care

  • Non‑surgical goals:

    • Reduce pain and stiffness, maintain function, and slow progression in mild cases while watching carefully for any neurologic worsening.​

  • Surgery goals:

    • Decompress (free) the spinal cord and nerves, prevent further deterioration, and, when possible, improve walking, hand use, and other neurologic symptoms.​

6) How surgery can fix the problem

  • Anterior surgery removes discs and bone spurs pressing the cord from the front, then stabilizes the segment with a graft, cage, or disc replacement.​

  • Posterior surgery removes part of the “roof” of the canal (lamina) or hinges it open, making more room for the cord, often combined with rods and screws if multiple levels are unstable.​

7) Risks of surgery (general and specific)

  • General: infection, bleeding, blood clots, and anesthesia or heart/lung complications.​

  • Anterior‑specific:

    • Swallowing difficulty (dysphagia), hoarseness from vocal‑cord nerve irritation, esophageal injury, and graft or hardware problems.​

  • Posterior‑specific:

    • Higher overall complication rates (about 15–25%) including blood loss anemia, surgical‑site infection, C5 nerve palsy, and spinal fluid leak.​

8) Chances surgery will work

  • For moderate–severe cervical myelopathy, evidence shows surgery provides better outcomes than non‑operative care, especially in stopping progression.​

  • Many patients experience meaningful improvement or stabilization of neurologic function after decompression, particularly if treated before severe, long‑standing deficits.​

9) Possible complications from surgery

  • Neurologic: worsening myelopathy or new arm pain/weakness in a small percentage (reported myelopathy worsening up to about 3.3% after ACDF).​

  • Structural: non‑union (pseudarthrosis), adjacent‑segment degeneration, and hardware or graft failure that may require re‑operation.​

  • Local: wound infection, postoperative hematoma (blood collection), or spinal fluid leak.​

10) Typical recovery from the condition (without surgery)

  • Some people with mild stenosis remain stable for years with careful management.​

  • In many with clear cervical myelopathy, symptoms gradually worsen—especially gait, balance, and hand function—if decompression is not done.​

11) Typical recovery after surgery

  • Early phase: hospital monitoring, pain control, neck support, and early walking; arm/leg symptoms may begin to improve within days to weeks.​

  • Months: structured rehab to work on balance, strength, and fine motor skills; neurologic recovery often continues over 6–12 months and may plateau thereafter.​

  • Some stiffness, residual numbness, or gait issues may persist, especially in long‑standing or severe cases.​

12) How long in the hospital

  • Many single‑ or two‑level ACDF or posterior decompressions require 1–3 days in hospital if uncomplicated.​

  • Multi‑level or combined surgeries, or patients with significant medical problems, may need longer stays and short‑term rehab.​

13) Long‑term outlook

  • With timely surgery, many patients have durable stabilization or improvement, though some continue to have residual deficits and neck stiffness.​

  • Without decompression in significant myelopathy, the long‑term risk is progressive disability, with increased falls, hand dysfunction, and potential bladder/bowel issues.​

14) Need for outpatient follow‑up

  • Non‑surgical: regular visits to monitor neurologic signs (gait, hand dexterity, reflexes, bladder/bowel), adjust therapy and medications, and repeat imaging if symptoms change.​

  • Post‑surgery: scheduled follow‑ups for wound checks, neurologic exams, and imaging (especially after fusion) to assess alignment and healing.​

  • Long‑term: ongoing rehab and fall‑prevention, attention to bone and cardiovascular health, and urgent reassessment if new weakness, numbness, or bladder/bowel changes occur.