What is Cervical Stenosis? | Jeffrey Cantor, MD

hi i'm dr jeffrey cantor from the canter spine center at the paley institute and what i want to do today is take a little bit of a deep dive into a problem that i see patients with on a regular basis and is one of the most common problems that we see and treat and it's very poorly understood by our patients and by the general public overall and that problem is called cervical stenosis and we see patients on a regular basis that are told they need surgery that sometimes it's an emergency and they come in and say i don't really have any pain i have these little tingles and and i don't really know why i'm getting conflicting opinions one doctor says it's an emergency the other doctor says wake wait till it gets worse and what i want to do is make you have an understanding of what cervical stenosis is why it's potentially a problem and it's important to understand that cervical stenosis is the most common reason for quadriplegia for losing the ability to walk and losing the ability to use the arms and legs and other functions of the body and folks over about 65 years old so it is a real issue and it's something that really is important to understand a little bit better so if you're told you have cervical stenosis it's a good idea to watch this and try to understand it so what is the term stenosis mean the body has pipes as tubes blood vessels the spinal canal things travel through conduit within the body and the term stenosis simply means when something starts to plug up those tubes so anything that gets into these tubes whether it's cholesterol or bone can compromise the inside of these channels and when it does these channels can get blocked and that's the main reason for coronary artery disease the blood vessels the tubes start to get obstructed and arthritis in the spine can also grow into the channels where the nerves travel through and cause a narrowing and that narrowing is called stenosis so what does that look like so this is a example of a spine a mri scan of a spine in the neck looking at a side view you see the bones that stack on top of each other and inside the bones there's a canal a conduit that the nerves travel through so if you look at that conduit what you can see is there's a channel and that channel has plenty of room and the spinal cord is this structure that goes through the center and in front of it and in back of it there's white and that white is fluid it's space and this is an example here of another individual that instead of having a nice clean line all of this stuff has grown into the canal and instead of the spinal cord having plenty of room you can clearly see between here and here it's severely pinched that's cervical stenosis and what it's doing is it's pinching the spinal cord that travels through that tube so why is this important and a lot of you follow professional athletics and there's a lot of discussion these days about concussions in athletes and we know that when you bump into the brain when you impact the brain the brain gets damaged it actually disappears and if you hit the brain enough time you can lose enough brain where you have difficulty thinking so the nfl has spent billions of dollars investing into looking at ways that they can identify or players that are developing brain injuries and alter uh that process what's really important to know that the spinal cord is basically an extension of the brain this is the base of the skull the face is here and there's a hole at the base of the skull called the foramen magnum and the brain travels through that hole and below below this point the brain turns into the spinal cord it's the same structure so above the base of the skull this structure is called brain below the base of the skull it's called spinal cord it's the same thing it's not like one's a liver and one's a kidney it's an extension of the same structure so why is that important well the brain is very delicate and when it gets bumped into into it gets damaged the spinal cord will do the same thing also notice that there is water there's space around the brain this white stuff is water it's called spinal fluid in the skull the brain floats in water inside a space it doesn't actually come in contact with the bones when you whack into it that impact goes across the water and actually can damage can damage the nerves without even physically touching the bone in the spinal canal there's also water and in the spinal canal you have a flexible group of bones and those that flexible group of bones is moving around the nerves so you have a tube the nerves in the center and when you move your head the bones move around your cord they don't come in contact with it when they do start to come in contact with the spinal cord and when something comes in contact with the brain it will damage it when brain and spinal cord get damaged they disappear they literally turn into liquid and that is visible on an mri scan so you can actually quantitate with traditional mri scans damage to the brain and damage to the spinal cord and we'll discuss a little bit later some of the more advanced ways of quantifying that so again the brain and the spinal cord are the same structure extremely delicate need to be protected when they're unprotected they can get damaged so why is that important it's important because the body has a certain amount of tissue and in the situation of the nervous system that tissue is is you're born with a certain amount and that's all you get normally again you're born with a hundred percent of your spinal cord over time that's going to degenerate and you're going to lose enough cord where at some point in time it may be difficult to do things like walk and the usual amount of time that take that takes is about 85 years so we see a lot of folks 85 and up that are really starting to stumble starting to have trouble walking and that can be natural attrition to the spinal cord where they really just don't have enough left to do the functions that they need a lot of people don't know that's happening we're going to describe why in a minute but this process is ongoing every day now if we bump into the spinal cord if we bang into it on a regular basis or one really big time we can speed up this process a lot so instead of having difficulty walking when we're 85 years old we'll develop difficulty walking a lot younger so the process of stenosis that pinches the cord speeds up the process of damage to the court of the natural attrition and instead of having a normal lifespan of our nervous system we can really decrease that lifespan where when we're 50 years old we're starting to have trouble walking and when we're 60 years old we might lose our our ability to walk completely so why is this unnoticed and the process is called neuroplasticity and what neuroplasticity is is the brain's ability to adapt and the spinal cord's ability to adapt to damage nova did a really nice description and a really nice show a couple years ago on neuroplasticity if you want to dive into that a little bit more the pbs nova nova tv show has a great description of what this is but in a really short description the spinal cord is made of billions and billions of cells and for make it simple that's going to be a billion cells and for argument's sake this area right here is the part of the spinal cord that's responsible say for moving your right arm when we develop stenosis and we start to bump into this what happens is those cells as i mentioned earlier they disappear they liquefy they get damaged now if they get damaged really fast and we lose a bunch of these cells we can lose the ability to use our right arm so if we really whack our spinal cord get in an accident a football injury or something like that you see football players get really badly injured they become quadriplegic and then a couple weeks later they get better it's because they only damaged an area of the spinal cord and they have the ability to recover so the brain will actually learn this function and it will transfer it over to other nerves so now instead of using this part of the brain to use your arm you're using this part of the brain so as long as the rate of damage doesn't exceed the rate that you can learn and recover you don't know this is happening it's completely unnoticed and patients can go on for 50 60 years with cervical stenosis and all of a sudden someday stop walking so why does that happen so as i mentioned as long as the rate of damage exceeds the rate of recovery or the rate of recovery exceeds the rate of damage we can we can basically compensate for this but when we get to the point where we don't have anything left as we lose more cells we can't recover anymore and that's when we start to lose function and if you go back to the previous slide that's when we get to the point where we're kind of out of gas so the spinal cord has lost enough tissue where it really doesn't have anything to recover anymore and then we start to stumble and start to fall and start to lose dexterity what are the symptoms of cervical stenosis how does the patient know they have it and and they can vary dramatically some patients come in with very little symptoms at all some patients come in with excruciating pain and it can vary from extreme symptoms to no symptoms and interestingly the patient that has no symptoms might be in a in a worse situation so this is a a picture of a cadaver specimen of a cervical spine and if you look from the side the base of the skull and the bones in the neck and if we turn this over on end this is what we're looking at the bones in the front the bones in the front called the vertebral body is here the arch of bone that covers the spinal canal is back here and the spinal canal through which the spinal cord travels is here and also it's really important to see is the amount of space between the bone and the spinal cord and that space is full of water the spinal cord also has nerve roots that come off the cord that function very differently this is a a different graphic of basically the same structure that might be a little bit easier to understand the spinal cord itself in the center has no sensation very similar to the brain when you actually have the brain exposed during surgery the patient can be awake with no pain and the spinal cord again is an extension of the brain so when you touch the spinal cord you can damage it with no sensation so when we're when bone or stenosis is growing into the area and pinching the spinal cord you can damage the cord with very little pain or very little discomfort as we lose cells we can start losing dexterity as we lose the ability of the cables within the cord to conduct signals we start to notice changes in our ability to manipulate our hands to navigate when we walk and to do fine motor skills so we might see changes in dexterity and no pain the spinal cord also has branches that come off the cord and these branches form what's called nerve roots so at every level nerves come out of the spinal cord and go into the arms and they go into the arms through what's called foramina and that's these holes off to the side and what's really important to know is these nerves are extremely sensitive so pressure pushing on the cord itself can cause damage with no pain but when a stenosis forms off to the side and pinches the nerve roots that causes severe pain it can cause neck pain it can cause arm pain it can cause pain in the whole body or all the above so the reason the symptoms are so variable in cervical stenosis is depending on where the bone is growing and where the stenosis is forming it will cause either pressure on a spinal cord pressure on the nerve roots called foraminal stenosis or both pressure on the spinal cord typically is the more dangerous problem but typically the least easy to to notice and to understand how does this form how do we get cervical stenosis how do we develop stenosis in the spinal canal in general and the basic process in the majority of cases is related to arthritis and what happens is as the body develops arthritis and this is an example of any joint this could be your knuckle it could be your knee it could be the joints in the neck and what happens when we develop arthritis our bones expand the outer part of the bone around the joint will start to get bigger now this is a finger it just gets bigger but in the spine when the nerves are traveling past here these bone spurs are going to grow into the space and actually come in contact with the nerves so arthritis is the most common process depositing bone that bone starts to encroach into the spaces that are normally occupied by delicate nerves causing either damage to the nerves pain or pain and loss of function once again we showed this slide earlier but this again is an example of the bones nice and clean with a very large channel with the cord traveling through and fluid in the front and back and here you can see the normal area of the bones and you can see the arthritis bone spurs forming and that formation in both directions is severely pinching the spinal cord so the underlying reason for stenosis in the vast majority of cases is arthritis and there's a number of different types spondylosis is the general term for arthritis there's something called ossification of the posterior longituded ligament there's a number of different types of arthritis but in general deposit of tissue in the spinal canal due to arthritis is the most common source of this problem and this is a cross-section view looking at the spinal canal on end once again the vertebral body in the front the plenty of space around the spinal cord the room around the cord with the cord in the center almost like a fried egg and here you can see a different patient where you have this big bone spur and a spinal cord instead of having plenty of room is just squashed inside that spinal canal so here is a normal spine here is arthritis growing into the spinal canal causing severe spinal stenosis when does this become important so a lot of patients come in and they have no symptoms mild symptoms are told hey you need to have an emergency surgery you might not walk someday other folks are told not to have surgery so so there it's been difficult and it's a lot of patients can have stenosis for their whole life and never get into trouble you can have quite severe stenosis and never have a problem or you can have severe stenosis and one day you're walking just fine the next day you sneeze and you can't walk at all so can we predict and there's been a lot of studies done there's been a lot of ways of looking at the basic anatomy the structure the sizes and the spaces available trying to predict who's going to get into trouble and who's not and what i'm going to do with this slide is is go over the basics of what those parameters are and they're not very accurate they're kind of guesses which is really what makes it difficult to determine this so once again we have the same basic slide and we have from the front of the channel to the back of the channel is the diameter of how much space there is for the cord in the center and normally that diameter is about 12 to 14 millimeters the spinal cord itself is usually about eight to nine millimeters and there's a tube around the front and the back of it that's about a half a millimeter on both sides so the space necessary for the cord and the bag that it sits in is about 10 millimeters so with 12 to 14 being normal 10 is about the size that the spinal canal is starting to get small where the bone is actually coming in contact with the cord the definition of stenosis in textbooks is anything less than or equal to 10 millimeters but in most patients it's not a problem so in patients that don't have hypermobility or joints that are loose and some people do but it's pretty rare and that's a separate discussion but in most patients that have normal structure to their spine and normal structure to their neck if you follow these people for a long time they don't get in trouble so even though 10 millimeters is described as a threshold for what is called stenosis sometimes it might cause some discomfort but very rarely is this dangerous there are cases that that it there may be variability to that eight millimeters is about the size when we start to get concerned about one in three patients that have a canal that that's eight millimeters will start to get into trouble and interestingly the patients that are already having problems when that diagnosis when that measurement is made are the ones more likely to get into troubles so out of three patients one will likely progress and about two won't so the question is what do you do if you have an eight millimeter canal and you don't have a lot of symptoms what do we do well in the past if you didn't have signs of cord damage and it's that's something that needs to be determined by somebody who really understands this if you don't have signs of what's called long track signs we typically will follow the patients we'll re-examine them in a couple of months and maybe even after their normal again a couple of years but we really can't predict who's going to get into trouble it's kind of a guessing game one in three is going to be in trouble two and three is not we really don't know who's going to have a problem so if you have symptoms and your eight millimeters will often recommend doing something about it to open it up and surgically fix it and if you don't have symptoms we usually will recommend at that point in the old in the old process to watch it six millimeters or less is really a problem it's dangerous there's so much pressure on the cord that it's very likely to cause problems at a rate that might be dangerous and a lot of patients at six millimeters even the ones that don't have trouble will get into trouble so at six millimeters we usually recommend some sort of a treatment so these are basic numbers these are are an overall kind of a guess of where you're going to be now if patients have symptoms if you're having progressive difficulty with dexterity progressive difficulty with balance if you're noticing that when you're walking up steps you're having more and more trouble navigating when you walk and you change directions you feel like you might fall if you're getting numbness in the hands when you move your neck if you're starting to to notice shocks and tingles in the arms or if you're having significant pain these parameters are a little bit less important because then once you're really significantly symptomatic surgery is more of an more of a necessity now it's also important to know that patients who do have cervical stenosis causing damage to the cord called myelopathy surgical solutions do better than non-surgically treated patients so if you have cervical stenosis and you are getting worse or you have a significant problem on an exam done by somebody who really knows how to how to look at that problem if you treat it you will likely do a lot better than not treating it long-term also it's important to know the longer you wait and the worse the problem the potentially more dangerous to treatment patients who have a relatively healthy cord that's getting damaged early if the canal is opened they do better than if they wait till they're really in trouble because of the potential issues associated with the surgery themselves and we're going to discuss that in a few minutes so these are two examples of patients with cervical stenosis and interestingly this one looks quite severe and this one looks quite mild this individual has no symptoms other than some mild tingles in the fingers this is an elite athlete who every time she moves her neck every time she jumps into a pool every time she does does something active gets exquisite tingles and numbness in her arms almost feels like she's getting electrical shocks in her arms and legs and is slowly but progressively losing strength in her arms and legs so this is a patient who's a lot older in their early 60s this is a patient in their early 50s this person is much more symptomatic and if you look at this one you'd expect this patient to have much more severe problems and that goes back to the rate of loss versus the rate of recovery and as i mentioned earlier spinal cord disease causes damage to the cord and it causes the cord to liquefy this is white of spinal fluid the gray is the actual nerve cells and when this cord gets damaged it turns into water water's white and if you look at these areas here you can see white spots within the cord now that's visible core damage that's enough of the actual spinal cord has been damaged and disappeared and liquefied where you could actually see it that's called myelomalacia myelomalacia is a bad sign but what it also shows is this process is very slow this is somebody who's losing cells and as they're losing cells they're recovering at a rate that doesn't allow this to be noticed so you're developing core disease but you don't know it this is quite significant and i would say that most surgeons would look at a neck like that if it's a healthy patient would recommend fixing it because this is somebody who can fall off the edge this is somebody who can be going around just fine and look up to watch an airplane and fall to the ground and never move again so this is one of those patients where somebody says hey if you get in a car accident you can become paralyzed it's not that common but what is common is once you get to the point where there's visible damage to the cord it's likely to progress if you're active if you're athletic if you're somebody who likes to ride a bike if you like to ski if you like to do things and you have a spinal canal that looks like that that's potentially dangerous going to this patient what's happening is even though the stenosis is mild and what's also interesting is if you measure this spinal canal it's about 10 millimeters maybe a little bit less so it doesn't meet the criteria for severe stenosis this individual has mobility of the bones where the bones are moving relative to one another and they're actually bumping into the cord and we're when they're doing that it's kind of like having concussions it's like getting hit in the head and when that happens it's whacking into the cord and causing significant damage so the difference between this person and this one is even though this looks less severe the impact is causing a more rapid degeneration of the spinal cord nerves and the degeneration is exceeding the ability of the nerves to recover so even though they may have less damage here the body can't recover fast enough so it's more symptomatic so also what's important here is the ability to determine whether or not this individual does in fact have a problem related to stenosis now in the past if you just look at the measurements the guessing measurements that we looked at before this is obviously a problem and this is not this is new this is exciting stuff and this is a very very different way of looking at the spinal cord and a lot of the research and a lot of the technology that that is leading to this new technique called diffusion imaging actually comes from the nfl and comes from the from the necessity to look at brains and determine how much damage there is so what this is this is a what's called a diffusion mri and this is a standard mri and what this is looking at is here's the brain and again the spinal cord and this picture the spinal cord looks like a gray tube you can't see the nerves you can't see how many nerves there are you can't see if there's any damage to the nerves you can just see the spinal cord kind of a shadow of it this is diffusion imaging and what this shows this structure here is this and what it shows is all of these fibers these are actually the nerves this shows us a healthy spinal cord so what we're looking at here is a very wide open spinal canal the spinal nerves traveling through and what it looks like when they're normal what the fusion imaging does it's a rapid mri scan that actually can track water molecules flowing through the neurons now neurons are like hoses they're pipes and the mri scan can the mri scan can detect the direction of the water molecules so when the nerves are not damaged it's going to flow through the nerves in a nice straight line like the mane of a horse when the nerves start to get damaged it's going to start to get frayed and you're going to start to lose that very clean look this is what diffusion imaging looks like on end so side view this is an end on view and when we look at the nerves a normal spinal cord is going to be completely red that shows that all the water all the tubes all the hoses are flowing water in the same direction around the outside you see a little bit of yellow and green yellow is a little bit of turbulence green is actually not normal flow and that's actually getting into the area around the cord where the spinal fluid is but inside the spinal cord you should see red or red and yellow once you start seeing in this particular color sequence greens and blues that's where the spinal cord is getting damaged and again this is the long view this is the view where it's cut in half looking at it on end so this is an example of a normal spinal cord and this is what a spinal cord looks like when it's damaged so this is somebody that we can actually look into their cord and say hey you've got some stenosis but your cord is pretty healthy versus you're starting to get into trouble we can quantitatively know are you starting to get to the point where this might be dangerous so two more patients two more examples this is an individual with relatively severe stenosis was sent here for surgery but doesn't have any symptoms this is the same patient that we looked at before doesn't really have severe stenosis visibly but has a lot of symptoms so if we look at their diffusion mri scans this initial patient with what was thought to be significant stenosis has a healthy spinal cord this person doesn't need surgery it probably doesn't even need need to be watched very frequently the cord is healthy even though the bone is growing into the canal it's not causing significant damage this is the patient it was a little bit confusing where there's a lot of symptoms but there isn't severe pressure but if we look at the actual nerves themselves what we can see is severe damage the cord instead of being nice healthy is frayed it's called an isotropy and that shows that the spinal nerves instead of the fluid flowing in one direction is leaking out kind of like if you run over your hose too many times in the driveway how is cervical stenosis treated and in patients that get to the point where it's been deemed necessary that it needs to be fixed they clearly understand what's going on and clearly understand the options there's a a a sequence of how this disease has been treated and we're going to go through a kind of a linear progression of how cervical stenosis has been treated some of the older techniques some of the new technologies and some of the newer techniques and initially the way that cervical stenosis was treated was called a laminectomy and a laminectomy simply means to remove the cover so if we look at this from the side and what we see is the the cord getting pinched from below there to above there something has to be done to open up that channel and with traditional techniques either we go from the front of the neck we take the bones out we remove them put a long spacer in or a number of spacers and we do what's called a fusion so we remove the pressure on the cord from the front and we essentially open up the channel by taking all of this stuff out the older solution is going from the back of the neck and taking the covers off and these covers are called lamina and the early operation is called a laminectomy so if we turn this on end we see the same thing so from the front of the neck we would remove the bone spurs and open up this channel and from the back of the neck we would basically cut this arch off and essentially just open it wide open and that seemed like a good idea but laminectomy is associated with a significant number of problems and one of the problems associated with laminectomy is when we do the procedure and the head is upright before the operation about one in three patients will end up with the head falling down and once that happens it's really not fixable and it's a big problem it's certainly difficult to go through the rest of your life looking at your feet so this is called post laminectomy kyphosis and there's a reason for it with traditional techniques and traditional technologies it's kind of difficult to prevent this so why does this happen why do we get a post laminectomy kyphosis why does the head fall down after a procedure and the answer is in the structure that holds the head up if you touch the back of your head there's a bump and if you slide down there's a second bump and those two bumps connect to a ligament a cable here's the bump in the back your head here's the the attachment to what's called the c7 spinous process this is called the nuchal ligament and that holds your head up that happens to be attached to the lamina the lamina that we remove in a laminectomy eliminate this cable and when that cable is eliminated the head falls down and it happens frequently enough where we've had to develop surgeons have had to develop techniques to rebuild what was taken out so if you look at a bridge and you put the spine sideways the tip of of c7 is here and the back of the skull is here and the cable goes from one stanchion to the other if you remove either one of these the bridge is going to end up in the water which again is the same thing that happens when you do a laminectomy and you remove these attachments to these cables this is the result what has been done to remedy this problem is we use what's called fusions so when we take the structure out we rebuild it and we go from the front of the neck we take the bones out we replace them with either long struts of bone or individual small bones and then we put a plate and we hold the bones together with plates and screws and it allows the structure that we remove to regrow it doesn't regrow normal it regrows in a solid piece so each individual bone that moved before is no longer moving the challenge with fusions and the problem with fusion is we take all the mobility that was normally in this area and shift it above and below so the motion that is lost in this area now has to be taken up by this joint and this joint and they weren't designed to handle that much stress when we do fusions we transfer stress above and below and that increases the rate of arthritis at the adjacent joints if you normally form stenosis and we increase the stress on the adjacent joints by doing a fusion what's going to happen is you're going to increase the rate of arthritis at the joints above and below the fusion and you're going to have a recurrence of the same problem so fusions particularly when they're more than two levels lead to increase in stresses and typically lead to additional fusions so when you fuse one area you're gonna probably fuse the next one and the next one and the next one at some point in time you're gonna kind of run out of space and then we're in a bad spot so even though fusions are very effective operations at getting rid of stenosis they do tend to lead to additional surgeries limited mobility and potential problems down the road and this is another example of an individual with a fusion and severe stenosis even life-threatening stenosis at the next level the other options for fusions is to do the fusion from the back of the neck now this is a large almost a 10 inch incision and because we take the ligament out we have to replace it and we replace it with screws and rods now again a very effective way at treating the stenosis but a very ineffective way at maintaining function mobility and lifestyle so most patients who have stenosis that had numbness and tingling and maybe some trouble walking when we do this operation we can often help them a lot but if you ask them a year later are they happy with the operation a lot of them would say they wish they had never done it because the limitation of mobility it also causes consistently significant neck pain and you'll never get the muscles that normally move the head back where they're supposed to be so a lot of strain a lot of achiness and a lot of discomfort after these operations this is an operation that i used to use to teach i do it very rarely because of the fact that most patients who've had this operation really don't like it so there's a new technology that really has changed things and the new technology is called ultrasonics and this is an older tool that we use to cut bone it's similar to a dremel it's sharp it spins it tears and on bone it very effectively cuts but when you put it next to something soft it's pretty dangerous this is an ultrasonic tool it uses vibration it's more powerful than the cutting tool it'll go through plastic and bone a lot faster than a traditional tool but because it's not sharp and because it doesn't spin it's very safe around delicate structures you can barely pop the balloon if you try to with this so this can be used in direct contact with nerves you can actually physically touch a nerve with this tool if you know how to do it it's not simple to use and you can work in very very small incisions so why is that important it allows us to use procedures that do not damage normal tissues so through an incision about that big versus an incision that's 10 inches we can remove all the pressure of the nerves without interfering with any of the normal structures so the cables that hold the head up are not interfered with and because they're not interfered with we don't have to rebuild them so by using ultrasonics and by using techniques where we work under the ligaments and we preserve their attachments and we preserve their normal mechanics and we're now actually reinforcing those ligaments with different suture techniques we can fix the neck without causing additional damage now that's important because this is a patient before surgery and after surgery and other than the fact that you can see that the spinal canal is small here and much bigger here meaning that the cord has plenty of room here and doesn't have any room here this looks pretty much the same as that so essentially what this has done is just plastically reshape the bones from the inside out saving all the ligaments no need for screws no need for rods no need for fusions no stress transfers so the probability of needing additional surgery is much much lower it's about one percent of about 15 years versus almost 15 to 30 percent per year with more than a three level fusion so these operations preserve function preserve mobility and this is something that can be used to intervene a bit earlier with because it does offer a better lifestyle option so say let's wait to you can't walk with fixtures to fix your stenosis that in the past used to be not unreasonable now is less reasonable because we have better options for treatment once again this is a comparison between the typical anterior fusion where structure has been removed and rebuilt with anterior plates or plates and screws in the front of the neck probability of adjacent level stenosis is quite high this is a traditional operation done from the back of the neck or posterior fusion where the ligaments were removed these screws and rods are replacing a ligament to hold the head up and this is a newer technique where the decompression the pressure removed from the spinal cord can be done inside and under the ligaments without interfering to their normal attachments and therefore they don't have to be rebuilt with screws rods and fusions a much better option now what's also important to understand is these are one type of stenosis there are many different situations operations have to be mixed and matched in other words sometimes we'll do a plastic operation with a single level fusion versus a multiple level fusion so we will decide which patient has what their individual situation is and we do an operation that saves whatever is working for them and whatever's good and we replace them we repair what's not good as opposed to essentially fixing the whole thing and then just rebuilding it with metal so i hope this was helpful i hope you're a little bit better informed about cervical stenosis what it is what some of the treatments are it was a little bit of a deep diet but there's still a lot more detail patients have stenosis with associated deformity where their head may not be in the right position things like that which makes it a bit more complicated this isn't a one-size-fits-all this is just a brief overview of what stenosis is why it potentially can be dangerous and problematic and should you or should you not consider surgery if you want to have somebody take a look at it if you want us to talk to you about this feel free to call us and again hopefully hopefully this was something that was useful to you thanks so much for watching

Channel: Jeffrey B. Cantor, MD

Views: 2,062,164

Rating: 4.8758907 out of 5

Keywords: spinal stenosis, Cantor Spine Institute, Dr. Cantor, cervical spinal stenosis, spinal surgery, neck pain, cervical stenosis, neck surgery, spine surgery, neck pain treatment, cervical stenosis treatment

Id: sK5BdbUY8LQ

Length: 41min 6sec (2466 seconds)

Published: Wed Apr 29 2020