Cervical Stenosis Treatment Options
The choice of treatment for cervical spinal stenosis (in the neck) depends on the severity of the symptoms. Non-surgical treatments are usually the first choice, but surgery might be necessary for severe cases and when a trial of non-surgical treatments does not improve symptoms. Each patient is unique and requires a personalized approach to achieve the best results.
- A cervical collar is sometimes recommended for a short period of time to provide support and stabilize the neck allowing it to rest.
- Over-the-counter nonsteroidal anti-inflammatory (NSAIDs) pain relievers such as ibuprofen or acetaminophen can reduce inflammation and pain. When these do not provide enough pain relief, prescription strength NSAIDS, muscle relaxants and oral steroids may be necessary for short-term use. Some antidepressants like amitriptyline can be effective in treating chronic pain. Gabapentin (Neurontinâ), and pregabalin (Lyricaâ) can help ease pain from damaged nerves. Topical medications such as creams and ointments that contain NSAIDS or local anesthetics may help.
- Physical therapy involves exercises to improve strength and flexibility and reduce pain in the neck. Cervical traction reduces pressure on the nerves. Massage therapy, ultrasound and electrical muscle stimulation may also be beneficial.
- If the pain is severe, an epidural steroid injection can help reduce inflammation and promote healing. Cervical epidural steroid injections deliver anti-inflammatory medications directly to the area around compressed nerves.
- Activity Modification involves refraining from strenuous activities, and modifying daily activities to avoid movements that cause or worsen symptoms.
- Anterior Cervical Discectomy and Fusion (ACDF): This is standard of care and is successful for the proper indications. Your Dallas Neurosurgical & Spine surgeon will make an incision in the front of the neck, remove the disc and bone spurs causing nerve compression, and then fuse the adjacent vertebrae with a bone graft and sometimes metal plates and screws. This procedure can help alleviate symptoms, but it also limits the movement of the affected segment of the cervical spine.
- Anterior cervical corpectomy and fusion (ACCF): This is a surgical procedure involves removal one or more vertebre and intervertebral discs from the cervical spine (neck) to alleviate pressure on the spinal cord and nerves. After decompression, the space that is left after removing the vertebrae and discs is typically filled with a bone graft and/or a cage made from bone or synthetic materials. This helps to maintain the normal height of the disc space and encourages bone growth.
- Posterior Cervical Laminectomy: In this procedure, your Dallas Neurosurgical & Spine surgeon will make an incision in the back of the neck and remove the lamina, the back part of the vertebrae that forms the roof of the spinal canal. This creates more space for the spinal cord and decompresses the affected spinal nerves.
- Posterior Cervical Laminoplasty: This procedure is similar to a laminectomy, but instead of removing the lamina, your Dallas Neurosurgical & Spine surgeon cuts one side and hinges it open to create more space for the spinal cord. It is less invasive than some other techniques and preserves spinal motion.
- Posterior Cervical Foraminotomy: This procedure is used when the compression is primarily at the point where the nerve root exits the spinal canal (the foramen). A small incision is made in the back (posterior) of the neck, and using a microscope or endoscope, the surgeon removes a small portion of the foramen to relieve the pressure on the nerve root.
- Cervical Artificial Disc Replacement: This is a newer surgical option in which your Dallas Neurosurgical & Spine surgeon removes the damaged disc through a small incision in the front of the neck and an artificial disc is inserted. The goal is to maintain or restore the original level of motion in the spine. Not everyone is a candidate for this surgery; it is typically only considered for patients with specific types of cervical disc problems and no significant joint disease or deformity.
Each of these treatments has potential benefits and risks. Some are minimally invasive. The choice of treatment will depend on a variety of factors, including the patient’s symptoms, the severity and location of the stenosis, the patient’s overall health and lifestyle, and the patient’s preferences.
It’s important to have a thorough discussion with a Dallas Neurosurgical & Spine neurosurgeon who can decide on the best treatment options for you. Our goal is to perform the least invasive, most effective procedures available tailored to your needs. We have offices in Plano, Frisco, and Dallas and offer virtual visits as well.