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Cervical stenosis (narrowing of the neck)Download as PDF
Narrowing of the cervical canal is like the narrowing of the lumbar spinal canal and can often then give rise to complaints.
Inside the spine is the spinal cord and the nerve roots. The spine consists of seven neck (or cervical) vertebrae C1 / m C7, 12 breast (or thoracic) vertebrae Th 1 t / m 12 th, 5 lumbar (or lumbar) vertebrae L1 / L5 , and the sacrum (or sacrum (S)) with the coccyx (tailbone). With the exception of the first two cervical vertebrae there is, between each two vertebrae an intervertebral disc. The vertebrae to move easily relative to each other is due to the inter-vertebral discs which are elastic, but also to spinal joints, which connect each of the vertebrae on both sides to the underlying and overlying vertebrae. Further, the spinal canal from top to bottom at each level formed by the vertebral arches, which are attached to the vertebral bodies. At the rear run out of this in a projection (by the protrusion) that in the middle can be sensed (the "backbone") on the back. In addition, the vertebral arches connected to each other by elastic bands, the yellow ligaments, which coating inside of the vertebral canal. Runs inside the spinal canal from the top down the spinal cord. The spinal cord is inside a sleeve of meninges, called dural sac, which it is hung. Shockproof in cerebrospinal fluid (CSF) On each the left and right spring height from the spinal cord nerve roots, which is then encapsulated in a cuff of brain membrane, leaving the spinal canal through openings which are bounded by the vertebral joints of two adjacent vertebrae.
The spine may show signs of wear especially in the elderly. Wear is moreover a natural aging phenomenon that occurs in all, although the extent to which it occurs, is individually different. This wear, also known as arthrosis, is known from all kinds of joints such as the hip or the knee. In response to the vertebral bone osteoarthritis is rampant, it is thicker, especially in the vertebral joints where thick ridges occur. This can take place on a level, for example C5 / 6, but usually on multiple levels, from C2 to Th1. Obviously the ridges narrowing the spinal canal and can therefore oppress the spinal cord. Also, they narrow the openings where the nerve roots of the spinal canal occurred. Because these openings in the cervical spine are not as widely occurs soon compression of the exiting nerve roots. In addition, also the yellow ligaments which thickens, which leaves still less space for the spinal cord and the nerve roots. Within the stenosed spinal canal However, how much space remains in the end, is further determined by the degree of wear and tear, and by the width of the channel, both of which may be different from person to person.
Other less common causes of narrowing of the cervical canal, the swelling of the tissue inflammation in rheumatoid joints of the cervical vertebra and the state after an injury of cervical vertebrae with displacement of bone fragments has occurred.
Narrowing of the cervical canal by the formation of botrichels of the vertebral bodies. A ledge at the level of C4/C5 indicates compression of the exiting root C5 there, but not the spinal cord. In the exiting nerve roots run branches of the motor and sensory pathways, causing compression of a root may give rise to pain, paralysis and sensory disturbances. The ledge at the height of C6/C7 gives crushing with denting of the spinal cord (myelopathy) extending therein with the motor and sensory pathways, whereby the motor and sensory functions threatened.
The signs and symptoms of cervical canal stenosis are the result of the tribulation (compression) of the spinal cord and / or nerve roots. One can imagine the pressure on the spinal cord causing direct mechanical damage them, especially if it happens repeatedly during movement, but more likely it is that the circulation of the spinal cord is disturbed by the flattening of nourishing blood vessels. The spinal cord can become thereof damaged, myelopathy (myelum means spinal cord) is mentioned. In the cervical spinal cord motor running long jobs, which are the nerve fibers that bundles the missions of the big brains pass to the cells in the spinal cord that control the muscles. Spinal cord also contains the long sensory pathways, these bundles of nerve fibers that entered in the spinal sense stimuli to the brains. When affliction of the spinal cord will therefore motor and sensory disturbances occur contained herein that patients express the movements of their legs no longer have control and lurching walk. On the one hand, this is because they have less power in their legs, (this is called a paralysis or paresis of the muscles), on the other hand it is also because they feel the position and movements of their legs less. In addition to a reduced position feeling, there is also a diminished sense of touch. By decreased sensation in the feet may appear they tiptoe while they have no stockings. In addition, the power reduction of spastic paresis or nature, that is to say that in spite of the reduced force the legs are weakened, but rather more rigid than normal so that it appears as if they stick to the ground. In addition to a disorder of the motor and of the feeling in the legs can also exist for urinary incontinence, that is to say that the patients do not have their urine bladder under control and at inopportune moments, can lose urine. Another phenomenon that sometimes occurs, is a sensation of electric current goes through the spine when bending the neck. These are all signs of affliction of the spinal cord. If the myelopathy progresses and the pinching of the spinal cord is not removed, it may result in a total interruption of the spinal cord, called a spinal cord injury that is characterized by complete paralysis and numbness of the body part below the level of the damage.
The signs of compression of the cervical nerve roots, also radiculopathy (radix meaning root), consist of shooting or radiating pain in the shoulder or arm, possibly accompanied by numbness or tingling, which aggravated or may be by bending generated or turning of the neck, or by stretching the arm.
The symptoms of cervical canal stenosis therefore very similar to those of the neck hernia, which is not entirely surprising, since both conditions can lead to compression of the spinal cord and nerve roots. Rise The emphasis is on the stenosis more on the pinching of the spinal cord and the neck hernia more like the roots. One difference is that the stenosis symptoms gradually commit to act, while complaints may arise as with thunder. Acute in the neck hernia Naturally, the cervical canal stenosis and neck hernia also combined, as often happens. For the uninitiated, the signs of the cervical canal stenosis resemble other spinal cord disease, such as multiple sclerosis. Therefore, neurological examination and imaging tests required to arrive at the correct diagnosis and to set the appropriate treatment.