Dr. Francis Farhadi explains the diagnosis of spinal stenosis and the treatment options that are available at our Comprehensive Spine Center.
Ohio State’s Comprehensive Spine Center offers multiple options for the treatment of cervical spinal stenosis.
Your spine, or backbone, protects your spinal cord and nerves, and allows you to stand and bend. Cervical spinal stenosis is the narrowing in your upper spine due to wear and tear. The narrowing in the neck area puts pressure on your nerves and spinal cord and can cause pain and disability.
Cervical spinal stenosis can lead to myelopathy, damage resulting from the spinal cord being compressed due to narrowing of ligaments, bones and discs surrounding the spinal cord.
What is Spinal Stenosis?
Spinal stenosis occurs most often in people older than 50. Younger people with a spine injury or a narrow spinal canal also are at risk. Diseases such as arthritis and scoliosis can worsen spinal stenosis. Some people have no symptoms. Others might have symptoms that appear gradually or suddenly, especially after a fall. These symptoms may include:
- Pain in your neck or back
- Numbness, cramping or burning pain in your arms or legs
- Balance problems
- Weakness and lack of coordination in the fingers, hands, arms and legs
Doctors diagnose cervical spinal stenosis and myelopathy with a careful history, physical and neurological exams, and imaging tests. Treatments include medication, physical therapy and surgery.
Source: NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases
Why choose Ohio State for treatment of cervical spinal stenosis and myelopathy?
Comprehensive Care: The Ohio State University Wexner Medical Center’s Comprehensive Spine Center offers multiple options for the treatment of cervical spinal stenosis. For most patients, surgery is not necessary. But if your quality of life is compromised, our spine surgeons can address the most challenging surgical cases, assisting those who cannot find help elsewhere.
Multidisciplinary Team: When you come to Ohio State’s Comprehensive Spine Center, we determine the source of your pain, diagnose the severity of your condition and choose the best, least-invasive treatment approach to restore you to the highest level of function possible.
Among the experts working for you at our Spine Center are:
- Physical medicine and rehabilitation physicians
- Physical therapists
- Spine surgeons with neurosurgical and orthopedic training
- Pain specialists/anesthesiologists
Physical Therapy Expertise: If you have mild cervical spinal stenosis, our physical therapists, who specialize in spinal conditions, work with you one-on-one to alleviate back pain and improve balance, strength and coordination.
Surgical Expertise: If your stenosis has progressed and requires surgery to protect your spinal cord, we have spine surgeons who are fellowship-trained in complex spine surgeries. We perform more complex spine surgeries than any other medical center in central Ohio.
Research: You will benefit from our involvement in national and international trials that provide you with the most current treatment methods for cervical spinal stenosis and myelopathy.
Spine Center Registry: Through Ohio State’s Comprehensive Spine Center registry, we track our patients’ outcomes, including physical function and quality of life, and compare these to national and international results to help us select the most effective treatment methods.
Diagnosing Cervical Spinal Stenosis and Myelopathy
As part of your thorough history and physical exam, we use the Modified Japanese Orthopaedic Association scale – an international standard – to assess the severity of your spinal cord damage. The scale measures extremity numbness, weakness and coordination problems, bladder and bowel problems, fine motor skills of the hands, and balance issues.
We routinely use magnetic resonance imaging (MRI) of the cervical spine to give us high-resolution pictures of the spinal cord and surrounding tissues.
Treating Cervical Spinal Stenosis and Myelopathy
Ohio State offers treatments ranging from physical therapy to the most complex neck and spine surgeries. Our physicians, therapists and other caregivers provide you with options that increase mobility and reduce pain. Most people who come to the Comprehensive Spine Center do not require surgery.
One of Ohio State’s strengths is our physical therapy program, with therapists who specialize in complex, degenerative spine conditions. Following a thorough examination of posture, neck mobility, strength and flexibility, our physical therapists customize a plan for you. We take into account any impairments or functional limitations you have. Typically, you will work one-on-one with a therapist on pain-relieving movement strategies and on improvements in balance, strength and flexibility.
Additional nonsurgical treatments include:
- Anti-inflammatory medications and neuropathic (nerve injury) pain medications for symptoms of burning, tingling and numbness
- Education on neck care and recommendations for specific needs (such as job demands, recreational activities, home set-up)
- Real-time ultrasound imaging (RUSI) of movement in the spine area to retrain the deep stabilizing musculature of your spine (a highly researched, evidence-based intervention)
- Training to restore balance and prevent falls
- Weight loss guidance, emphasizing healthier eating and exercise to ease pressure on the spine
- Pilates, yoga and aquatic therapy to strengthen back muscles
You may need surgery if you have moderate to severe cervical spinal stenosis with myelopathy. Surgery can prevent further spinal cord damage and perhaps allow the spinal cord to recover over time, with the aid of physical therapy.
We may conduct additional studies as we evaluate you for surgery:
- Electromyography (EMG), which can detect muscle weakness due to nerve problems
- Computed tomography (CT) scan
- Magnetic resonance imaging (MRI)
Ohio State’s spine specialists perform more than 500 complex spine surgeries a year, more than anywhere in central Ohio. We use the least invasive surgery possible to protect your spinal cord from progressive damage:
- Decompression surgery, which can be performed from the front or back of the neck.
- Laminectomy is performed from back of the neck, removes part of the vertebra (neck bone) and relieves pressure on your spinal cord. Our surgeon may use metallic plates and screws to prevent slippage of one vertebra over another.
- Spinal cord decompression from the front is performed by removing bone and a disc or discs and fusing vertebrae.
- Spinal fusion surgery is sometimes used in the laminectomy procedure to fuse vertebrae and restore stability to the spinal column; for cord decompression from the front, spinal fusion and using metallic plates and screws are always part of the procedure.
Ohio State performs innovative research in the laboratory, as well as through clinical trials.
Areas of focus include:
Riluzole study [Efficacy of Riluzole in Patients with Cervical Spondylotic Myelopathy Undergoing Surgical Treatment, sponsored by non-profit AO Spine]: We are the only center in Ohio — and one of approximately only 12 in North America — participating in a study of the medication riluzole for patients who are candidates for surgery for myelopathy. We are helping to determine if taking riluzole in the weeks before and after surgery protects spinal cord nerve cells. Riluzole has already been approved for amyotrophic lateral sclerosis (ALS). We are evaluating the drug’s effectiveness in treating the severe symptoms of cervical stenosis, such as uncoordinated fine finger movements, gait imbalance, numbness and burning pain in the arms and legs.
Study of Stem Cell Mixture for Bone Fusion [Cellentra™ Viable Cell Bone Matrix (VCBM) Anterior Cervical Discectomy and Fusion Outcomes Study (VCBM/MaxAn®)]: We are participating as a high-volume center for a randomized, blinded study to evaluate a stem cell mixture to promote fusion of bones in cervical spine surgeries.