Cervical spondylotic myelopathy
Cervical spinal canal stenosis is a narrowing of the canal located in the middle of the neck vertebrae and through which the spinal cord passes and/or the channels through which the nerves leaving the spinal cord go to our colon. Along with this narrowing, there may be a deterioration in the shape of the neck, cauma or rotation forward and backward in the neck vertebrae. Narrowing may be due to degeneration in the bones and thickening of the joints in the back of the spine, calcification of the ligaments located in front and behind the canal, and degeneration and herniation of Decals consisting of soft cartilage located between the vertebrae
Signs and Symptoms
It usually manifests itself with complaints related to nerve root (radiculopathy) or spinal cord pressure (myelopathy). However, there may not be complaints and findings in patients with every narrow channel. In addition, there is weakness and loss of function in the arms and legs in patients in whom symptoms occur. Oct. A person associated with spinal cord damage in the cervical region called cervical myelopathy, which develops as a result of a narrow cervical canal, may have difficulty in fine tasks, especially involving finger movements, such as knotting his shirt in his daily life, 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. Complaints about the legs, on the other hand, occur as difficulty walking, weakness in the legs and can progress to the inability to walk unaided. Another of the complaints of patients with cervical myelopathy is urinary incontinence. With the progression of the disease, inability to hold urine and stool, involuntary abduction may occur. These complaints may vary from patient to patient, and the progression of these complaints may occur for different periods of time in each patient.
Early diagnosis is very important in this group of diseases. With the treatment to be applied after early diagnosis, the progression of patients’ complaints can be prevented. Diagnosis of the disease begins with listening to the patient’s complaints and asking the doctor questions in accordance with them. The clinic usually starts insidiously and does not give any signs at first. The rate of progression of the disease varies, and complete recovery after the development of myelopathy is rare. For this reason, early diagnosis and treatment of the disease are the most decisive factor in terms of recovery of the disease after surgery. In 75% of cases, worsening in episodes during stable periods, slow progression in 20% and sudden worsening in 5% were observed. As myelopathy progresses, both legs become more weak and spastic (muscle stiffness).
Diagnosis
Direct X-rays of the neck may not provide sufficient information to confirm the diagnosis of cervical narrow canal. 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 there is also suspected, a computed tomography should definitely be performed, and if surgery is necessary, planning should be done accordingly.
Treatment
In cases with radiologically detected narrow duct, but not causing complaints and findings, and in cases with a mild cervical narrow duct diagnosed after the evaluation of a specialist, non-surgical methods are the first option for treatment. Increasing weakness in the arms and legs and determining that it progresses over a short period of time, while daily walking capacity decreases, brings the surgical option to the forefront in such cases.The purpose of surgical treatment is to eliminate the pressure on the spinal cord and nerve root, to fix it if there is a mechanical blockage in the spine. This goal can be achieved with various surgical techniques. Surgeries are performed on the front or back side of the neck. But sometimes in patients with advanced and long segment stenosis, surgery from both the front and back side may rarely be required.
Although the duration of hospital stay of patients after surgery varies depending on the surgery performed, it is necessary to stay in the hospital for 1 night only after disc-related surgeries and for 5-7 days after more complicated surgeries. After surgery, patients are taken to a rehabilitation facility determined by the surgeon and the postoperative recovery process is tried to be shortened.
Prognosis
Improvement is observed in 70-80% of the patients who underwent surgery according to their condition before the operation. The main goal is to stop the disease from getting worse. Passing the patient’s complaints, improving the neurological examination can occur together with appropriate rehabilitation programs The patient’s advanced age, the presence of heart and lung disorders, smoking and alcohol use, the presence of underlying diabetes can slow down the patient’s recovery after surgery and negatively affect. The severity of the patient’s clinical condition before surgery and the fact that his disease is advanced also reduces the benefit that he will see from the operation. Therefore, early diagnosis and early treatment are very important in these diseases.
