Cervical herniated disc spinal stenosis is a type of central vertebral canal impingement that is enacted by a bulging, herniated or ruptured intervertebral spacer in the neck. Typically the clinical presentation of disc-related stenosis occurs when a central herniation applies pressure to the thecal sac and possibly even compresses the spinal cord itself. Thecal sac compression is usually a non-issue, since it does not typically produce pain or related neurological consequences. However, when the spinal cord is compressed, the symptoms of cervical stenosis can be both nightmarish and disabling.
This topical essay examines the diagnosis of stenotic changes that are caused, or contributed to, by cervical disc pathologies. We will also detail the most effectual methods of treatment for cervical herniated disc spinal stenosis that can resolve the canal impingement and relieve the accompanying symptomatic expressions.
Stenosis describes the condition when the central vertebral canal becomes less patent. This is not a painful condition and should not produce any symptoms, until the degree of constriction begins to compress the spinal cord.
Intervertebral discs might rarely herniate anteriorly, which are virtually always non-problematic for the patient. Most discs will bulge or rupture posteriorly, directly into the spinal canal. Since disc nuclei are not hard structures, the herniated disc will rarely compress the spinal cord, unless it is a large and extremely pressurized protrusion. In most instances, the herniation will simply spread out to apply diminished force to a larger region of the thecal sac, rarely causing compression of any neurological tissues.
Occasionally, disc-enacted single nerve root compression may occur, rather than spinal cord compression, in the central canal, in the lateral recess, in the neuroforaminal space or even after the nerve root has successfully exited the spinal canal completely.
Since spinal stenosis is a normal part of getting older, many people already have partial canal narrowing due to arthritic changes, spinal curvatures, injuries or congenital predisposition. In these instances, a disc bulge will have a greater chance of successfully compressing the spinal cord, eliciting symptoms.
Likewise, old herniations can calcify through a process called ossification, becoming bony and demonstrating a greater likelihood of providing a compressive force against the central neurological tissues. This is especially true when osteoarthritis is already fully present in the region, since the calcified herniations can form osteochondral bars, which are known causes of many cases of symptomatic stenosis.
Technically, cervical herniated disc spinal stenosis is not a symptomatic condition unto itself. The diagnosis merely describes a situation in which the spinal canal is made narrower than is usual due to an intervertebral bulge or rupture.
It must be made clear that disc abnormalities are extremely commonplace in the neck, especially between C4 and C7. Virtually all adults have noticeably degenerated discs in the neck and a majority will demonstrate at least one bulge or herniation in the same region.
While most cases of disc-enacted stenosis are asymptomatic, some instances can enact serious neurological effects on a patient. Being that the actual spinal cord can be affected in some cases of cervical spinal stenosis, the neurological compression can influence the body anywhere below the affected level, making a precise diagnosis difficult. Many patients with coincidental herniated discs in the lumbar region are misdiagnosed, when their lower body symptoms actually originate in the cervical spine.
Therefore, it is of critical importance that all patients understand that although they might have sciatica, weakness in the legs, difficulty standing, difficulty walking, bowel or bladder symptoms or sexual dysfunction, their symptoms might be due to stenotic changes in the neck, rather than the more commonly diagnosed possibility of a lumbar causation.
Cervical imaging will confirm or rule out structural contributors in the neck, so MRI or CT should always be performed prior to beginning any treatment protocol.
Cervical herniated disc spinal stenosis is one of the dorsalgia conditions that can be treated in many different ways. Once again, it must be mentioned that most cases of central stenosis do not require any treatment, since they do not produce pain or nerve dysfunction. However, even in these innocent scenarios, the condition should always be regularly monitored by a spinal neurologist to chart possible progression of the canal narrowing.
When cord compression is occurring, and generating obvious symptoms, then treatment is strongly advised. Failure to treat the stenosis might result in lasting neurological deficits, which can diminish physical functionality for life. In extreme scenarios, stenosis can also increase the risk for serious health threats, such as strokes, heart disease, organ damage, paralysis and even death.
Treatment for disc-related stenotic changes may or may not be necessary. Many disc pathologies resolve all by themselves, simply with the passage of time. Others might not resolve and some might intensify, especially when ruptures and sequestered disc nucleus proteins ossify and become part of a virulent arthritic problem in the central canal.
Treatment choices range for nonsurgical moderate care practices, like modern spinal decompression, to surgical interventions. Depending on the overall nature of the condition, some disc pathologies can be effectively treated with minimally invasive procedures, like nucleoplasty, IDET or partial discectomy. Meanwhile other stenosis conditions might need to be treated with a combination of surgical therapies, including full discectomy, facet joint procedures, laminectomy, corpectomy and spinal fusion.
To learn more about the best treatment option for your specific type of symptomatic disc-related cervical stenosis, we recommend talking to several different types of doctors, including at least one non-surgeon. Even if herniated disc surgery is deemed to be needed, there are many procedural options to choose from, so it is best to find the least damaging path that can resolve the condition, in order to minimize the risk and trauma involved in the surgical journey.