Degenerative cervical spinal stenosis: current strategies in diagnosis and treatment

Abstract

Introduction: Cervical spinal stenosis has become more common because of the aging of the population. There remains much uncertainty about the options for surgical treatment and their indications, particularly in cases of cervical myelopathy.

Methods: In order to provide guidance in clinical decision-making, the authors selectively reviewed the literature, according to the guidelines of the Association of Scientific Medical Societies in Germany.

Results: Cervical myelopathy is a clinical syndrome due to dysfunction of the spinal cord. Its most common cause is spinal cord compression by spondylosis at one or more levels. Its spontaneous clinical course is variable; most patients undergo a slow functional deterioration. Surgical treatment reliably arrests the progression of myelopathy and often even improves the neurological deficits.

Discussion: The available scientific data are too sparse to enable evidence-based treatment of cervical myelopathy. Early surgical intervention is often recommended in the literature. Controversy remains regarding the choice of the appropriate surgical procedure, but there is consensus on the suitable options for many specific clinical situations.

Keywords: anterior decompression; cervical myelopathy; cervical spinal stenosis; posterior decompression; surgical treatment.

Figure 1

Schematic sagittal image of the degenerative changes in the cervical spine. As a result of vertebral disk protrusion (blue), spondylophytes (dark blue) and hypertrophy or folding of the ligamentum flavum (yellow), the spinal canal is restricted, the available space for CSF is reduced (pale blue) and the spinal cord is compressed (green). Slippage in the spine (olisthesis) or instability can also damage to the spinal cord.

Figure 2

Sagittal MRI in T2- (left) and T1- weighted imaging. There is stenosis at the level of C 4/5, caused by prolapse of the disk and retrolisthesis. The hyperintense signal in the T2 image (arrow) is a sign of the spinal cord affection. MRI, magnetic resonance imaging; C, cervical vertebral body.

Figure 3

Lateral x-ray of the cervical spine before (left) and after (right) ventral surgery. The retrolisthesis at the level of C 4/5 with dorsal spondylophyte is clearer than in the MRI. After intercorporal spondylodesis with a titanium cage and plate osteosynthesis, the retrolisthesis is corrected and the spondylophyte resected. MRI, magnetic resonance imaging; C, cervical vertebral body.