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Surgical therapy of cervical spinal stenosis and herniated disc


The cervical spinal canal stenosis and also the herniated disc lead to the use of the reserve space around the spinal canal due to the narrowing of the spinal canal (epidural-subarachnoidal space) and thus to a direct pressure effect on the spinal cord and to the abolition of the sliding ability of the dural sac in the spinal canal. In addition, there may be a narrowing with compression of the exiting nerve root in the foramen area.

The possible consequences can either be slow, chronic damage to the spinal cord or, in the case of a minor trauma, acute symptoms with paraplegia. The pressure on the exiting nerve root can cause radicular paralysis (partial paralysis in the arm).

The mechanism of the acute problem: due to the lack of reserve spaces with missing epidural fatty tissue and liquor around the spinal cord and the direct pressure on the spinal cord with fixation, any severe bruise is transferred directly to the spinal cord and can cause acute damage with a cross section.

In the slowly progressive course, direct pressure, fixation and compression of the vessels lead to ischemia in the myelon with the then visible signs of scarring in the MRI. In the MRI, the existing damage is shown in the form of myelopathy.

Clinically, the cervical stenosis can manifest itself with pain in the form of radicular or only local neck pain. Neurologically, the entire spectrum from slight failures with paraesthesia, fine motor disorders of the OE, coordination problems of the OE and UE to severe failures with ataxia and varying degrees of cross-sectional problems is possible.

The diagnosis with X-ray and MRI of the cervical spine should be made early on, even before there is irreversible damage to the spinal cord, in the form of scarring as myelopathy visible in the MR.

Surgical treatment can usually improve the neurological deficits but not reduce them, so there is an absolute necessity to make the diagnosis early and to start the therapy.

Surgical therapy is based on the radiological findings and may be required from the ventral segmental or by resection of the entire vertebral body or from the dorsal with decompression and possible stabilization, in some rare cases also combined. Additional dorsal stabilization is always required if there is no lordosis of the cervical spine or a multi-segmental laminectomy is required.

Segmental ventral decompression and stabilization:

Cage and plate cage with screw fixation

Isolated dorsal decompression with stabilization:

Stenose C2- 7, dorsale Dekompression und Stabilisierung C1 – Th1

Summary: The cervical stenosis and the prolapse represent a clinical picture to be taken seriously, failure to observe can lead to severe neurological deficits with irreversible damage to the spinal cord. Diagnosis is made clinically and using MRI. Surgical therapy should take place at an early stage, before irreversible damage, since in the presence of scars only an improvement but not a complete remission is possible.

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Dr. Helmut Hiertz