Cervical spinal canal stenosis is the narrowing of the canal in the middle of the neck vertebrae through which the spinal cord passes and/or the canals through which the nerves exit from the spinal cord and go to our arms. Along with this narrowing, there may be distortion of the shape of the neck, anterior and posterior cavities or rotation of the neck vertebrae. Contraction; It can be caused by degeneration of bones and thickening of the joints at the back of the spine, calcification of the ligaments in front and behind the canal, and degeneration and herniation of the soft cartilage discs between the vertebrae.

Signs and Symptoms

It usually presents with complaints related to nerve root (radiculopathy) or spinal cord compression (myelopathy). However, every patient with narrow canal may have complaints  and no symptoms. Patients with symptoms also have weakness and loss of function in the arms and legs. Due to the damage to the spinal cord in the cervical region called cervical myelopathy, which develops as a result of the narrow cervical canal, the person may have difficulties in daily life, such as knotting his shirt, not being able to open and close the door handle, not being able to open the jar lid, not being able to brush his teeth, especially with finger movements. Complaints related to the legs appear as difficulty in walking and weakness in the legs and may progress to the inability to walk unaided. Another complaint of patients with cervical myelopathy is urinary incontinence. As the disease progresses, urinary and stool incontinence and involuntary incontinence may occur. These complaints may vary from patient to patient, and the progression of these complaints may occur at different times in each patient.

Early diagnosis is very important in this disease group. With the treatment to be applied after early diagnosis, the progression of the patients' complaints can be prevented. The diagnosis of the disease begins with listening to the patient's complaints and asking questions from the physician in line with these. The clinic usually starts insidiously and does not show any symptoms at first. The rate of disease progression is variable, and complete resolution is rare after myelopathy has developed. Therefore, early diagnosis and treatment of the disease is the most decisive factor for the recovery of the disease after surgery.  In 75% of the cases, worsening in attacks in stable periods, slow progression in 20%, and sudden worsening in 5% of cases were observed. As the myelopathy progresses, both legs become weaker and spastic (muscle stiffness).

Diagnosis

Direct X-rays of the neck may not provide sufficient information to confirm the diagnosis of cervical stenosis. Magnetic Resonance Imaging (MRI) is usually used to make this diagnosis. MRI shows the narrow cervical canal and compressed spinal cord in great detail. If calcification of the ligaments is suspected, computerized tomography should also be taken and if surgery is necessary, planning should be done accordingly.

Treatment

Non-surgical methods are the first choice in the treatment of cases with radiologically detected narrow canal but not causing any complaints or findings, and in cases with mild cervical stenosis diagnosed after the evaluation of the specialist doctor. The increase in weakness in the arms and legs and the detection of its progression in a short time, and the decrease in daily walking capacity, bring the surgical option to the forefront in such cases. The aim of surgical treatment is to remove the pressure on the spinal cord and nerve root, and to fix it if there is a mechanical gap in the spine. This goal can be achieved with different surgical techniques. Surgeries are performed from the front or back of the neck. However, sometimes patients with severe and long segment stenosis may rarely require both anterior and posterior surgery.

Although the duration of hospital stay of the patients after the surgery varies according to the surgery performed, it is necessary to stay in the hospital for 1 night only after the surgery for the disc, and for 5-7 days after the more complicated surgeries. After the surgery, patients are taken to a rehabilitation determined by the surgeon and the post-operative recovery period is tried to be shortened.

Prognosis

In 70-80% of patients who underwent surgery, improvement is observed compared to their pre-operative condition. The main goal is to stop the worsening of the disease. The improvement of the patient's complaints and the improvement of the neurological examination can be achieved together with appropriate rehabilitation programs. The severity of the patient's pre-operative clinical condition and the progression of the disease also reduce the benefit of the surgery. Therefore, early diagnosis and early treatment are very important in these diseases.