Conditions and Disorders

Symptoms: Symptoms and the mechanisms which produce them are similar to those associated with disc herniation; however, the two processes are fundamentally different in that disc herniation is an acute event, while stenosis is a chronic, slowly progressive process, which may be punctuated by episodes of worsening. Patients may have symptoms of radiculopathy; usually manifested as shooting pain into the extremities associated with focal numbness or weakness in the distribution of a particular nerve root. In addition, patients may also present with cervical spondylotic myelopathy. (CSM).

Treatment: Unlike patients with cervical disc herniation, most patients with spondylotic myelopathy do not improve with nonoperative treatment, because of the progressive degenerative nature of spondylotic disease. Patients treated nonoperatively must be followed closely for worsening of myelopathy. The surgical options are anterior or posterior decompression. Anterior approaches are similar to those described for herniated cervical disc and may be performed at multiple levels as appropriate. Alternatively, the entire vertebral body may be removed (corpectomy) between adjacent levels of spondylosis, or several bodies may be removed. A bone graft is placed for fusion. To reinforce long grafts, a plate and screws are usually placed. Posterior decompression involves a laminectomy at the affected levels, and may or may not require a fusion with metal constructs. Most surgeons today would probably prefer an anterior procedure when feasible.