Cervical Central Canal Stenosis | Myelopathy

Cervical Central Canal Stenosis and Myelopathy Overview

The majority of people living will experience neck pain at some point in their lives. Causes of neck pain can be the result of genetic type degenerative changes and the effects of trauma, sports and occupation, or other cervical spinal diseases. Of these individuals, some will develop cervical central canal stenosis. Symptoms from this condition can lead to pain, weakness and numbness in the cervical spinal canal. This is a condition where cervical canal narrowing puts pressure on the spinal cord or places the spinal cord in jeopardy with a fall or impact. This cervical canal narrowing that essentially leads to spinal cord pinching is a condition that is more frequent in the aging population especially by those who are over 50 and have endured wear and tear on the spine.

Many patients who are suffering from cervical central canal stenosis and myelopathy have experienced trauma in the neck area either through an injury or accident. Sometimes, the cervical stenosis symptoms take years to surface as the degenerative process that causes spinal (cervical) canal narrowing by bone spurs and disc bulging is the hallmark of this disorder. Some individuals have congenital narrowing which means they were born with neck canal narrowing and the symptoms can occur earlier in life.

Biomechanics

It is important to know what happens to a spinal canal with neck motion. Bending the head forward causes the spinal canal to enlarge by as much as 30% and conversely, bending the head backwards causes reduction (or narrowing) of as much as 30%. With spinal stenosis, as the cervical canal narrowing takes place, there is pressure placed on the spinal cord and it begins to dysfunction-a condition called myelopathy. Degenerative myelopathy of the neck causes cervical pain. In the neck, there are occasions where the cord can be acutely pinched with a forceful blow to the front of the head causing the head to bend violently backwards, a condition called central cord syndrome-a type of spinal cord injury. Please see the section on spinal cord injuries to find out more about central cord syndrome.

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(Please keep reading below for more information on this condition.)

Cervical Central Canal Stenosis Symptoms

The spinal cord is an extension of the lower part of the brain. It is not just a message delivery system but has some important complex processes to keep muscle coordination and bowel/bladder function normal. When spinal cord pinching and spinal cord compression occurs in a condition called cervical central canal stenosis, the spinal cord dysfunctions and myelopathy results.

Myelopathy has been called the great imposter of causes of neck pain as the symptoms are so unusual that the condition is rarely diagnosed except by a spine specialist. The symptoms start with imbalance with walking. The symptoms can be very subtle in the beginning. Walking in a very dark room (no visual clues) and stumbling can be one of the first signs. Imbalance can extend to the hands. Inability to use the hands for fine motor skills (picking up a dime off a smooth counter, zipping a zipper, difficulty with putting a key into a lock or even a change in handwriting) can be telling. Symptoms can progress to unusual pins and needles sensations and feelings into the arms or legs, electric like zapping sensations down the back or arms with neck motion (L’hermitte’s sign), bowel and bladder problems and neck pain. Weakness can be noted in the legs.

There are specific signs that occur with myelopathy that are apparent on a careful physical examination and can help confirm the presence of this condition. An MRI of the neck (and occasionally of the thoracic spine) is mandatory if myelopathy is suspected.

Cervical Central Canal Stenosis Treatment

Non-Surgical

Degenerative myelopathy of the neck is a condition that is not commonly treated without surgery as it is a continuing injury to the spinal cord and only in rare exceptions is surgery recommended.

Surgical

There are surgical procedures of the spine that can help relieve the pressure on the spinal cord or prevent a future injury to the cord. Surgery for cervical central stenosis is designed to relieve pressure from spinal cord compression and/or spinal cord pinching and if there are already significant symptoms present, the relief of pressure on the cord should prevent future problems but may not be effective in relieving present symptoms. Surgery can include:

An anterior fusion (ACDF) can decompress the cord and also create stability to segments that are currently unstable and injuring the spinal cord
A decompressive laminectomy can be performed to create more space in the spinal canal for the nerves that exist there; this is done by removing the vertebral roof (lamina) and making more space for the cord.
A posterior laminoplasty can also be performed and is done by lifting the lamina to one side. This expansion helps to open the spinal canal and helps to retain more spinal stability.

For more information on cervical central canal stenosis and degenerative myelopathy of the neck, or for additional resources on the causes of neck pain and other cervical spinal diseases, please contact Dr. Donald Corenman, neck doctor and spine specialist in the Vail, Aspen, Denver and Grand Junction, Colorado area.

Related Content

(Click to Enlarge Image) This is a side view MRI of severe cervical stenosis and spinal cord compression (note the brighter signal in the spinal cord at the arrow).

(Click to Enlarge Image) This is a picture of atrophy of some hand muscles (the thenar eminence) that commonly accompanies cervical myelopathy. My finger points to the muscle wasting.

Donald Corenman, MD, DC

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81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

Cervical Central Stenosis and Myelopathy