ABOUT
Cervical spondylotic myelopathy (CSM) refers to inadequate function of the spinal cord due to compression by bony outgrowths (spondylosis), ossification of ligaments or by large disc herniations.
Over time, the normal wear-and-tear effects of ageing can lead to a narrowing of the spinal canal. This compresses — or squeezes — the spinal cord. CSM can cause a variety of symptoms, including pain, numbness, and weakness. Symptoms usually begin after the age of 50 but can occur earlier if there was an injury to the spine at a younger age. Many people will have a steady progression of their disease. Once symptoms start, they tend to continue. Typically, the disease progresses slowly over several years.
SYMPTOMS & INVESTIGATIONS
The following are the symptoms and investigations undertaken for Cervical Laminectomy.
The spinal cord serves as the conduit for the transmission of signals between the brain and the rest of the body. When the spinal cord is slowly compressed, people may develop symptoms such as:
- Tingling and numbness in the hands and legs
- Weakness: difficulty in buttoning shirts, clumsiness, dropping things
- Difficulty walking (loss of balance), wide-based gait
- Coordination problems: changes in handwriting and feeding
- Neck pain and stiffness
X-rays are useful to look at the alignment of the neck. Magnetic resonance imaging (MRI) is the ideal investigation to look for compression of the spinal cord. CT scans allow better-detailed cross-section images showing bone spurs and the size of the spinal canal and are ordered in special situations.
TREATMENT
Both surgical and non-surgical options are available and the treatment depends upon the condition of the patient
In some people with early myelopathy without significant compression in the cord, medical management is initiated. Soft collars allow the muscles of the neck to rest and limit neck motion. This can help decrease the pinching of nerve roots with movement. Soft collars should only be worn for short periods of time because long-term wear can decrease the strength of neck muscles. Improving neck strength and flexibility with simple exercises may lessen discomfort. Nonsteroidal anti-inflammatory medications (NSAIDs) can reduce swelling and painful symptoms.
Surgical treatment includes anterior cervical decompression or posterior surgeries. Posterior decompression procedures include Cervical Laminectomy and Cervical Laminoplasty and are advised when there is multi-level compression of the spinal cord.
When the spinal canal has become too small due to injury or disease, it may be made larger by the use of laminectomy. By increasing the space for the spinal cord and nerve roots, laminectomy reduces the spinal cord compression and may help prevent progression of neurological deficits. An incision is made down the back of the neck to expose the cervical vertebrae. Then the laminas are cut all the way through on either side of its attachment to the vertebra. The lamina with the intervening ligaments is removed creating more room for the spinal cord and nerve roots