15. Cervical spinal stenosis

Cervical stenosis is narrowing of the spinal canal that may compress the spinal cord and/or nerve roots. Clinically significant compression may manifest as cervical myelopathy and radiculopathy and substantially impair quality of life.

Causes:

• degenerative changes in the intervertebral discs and facet joints;

• hypertrophy of the ligamentum flavum;

• vertebral body osteophytes;

• a congenitally narrow spinal canal;

• post-traumatic changes.

Symptoms:

• neck pain radiating to the shoulders or arms;

• numbness, tingling, and weakness in the limbs;

• impaired fine hand movements;

• ataxia and unsteady gait;

• in severe cases — paresis and bladder and bowel dysfunction.

Anterior cervical discectomy and fusion (ACDF) provides decompression and stabilization while altering biomechanics and eliminating movement at the operated segment. Open posterior approaches may involve extensive muscle dissection, postoperative pain, and scarring. The choice of approach depends on the nature of compression and the need for stabilization.

We use biportal endoscopic spine surgery (BESS/UBE) to decompress the cervical spinal canal. Technical capabilities of the method:

• independent viewing and working portals for the endoscope and instruments;

• a wide view and anatomical orientation similar to microsurgery;

• the ability to use standard surgical instruments;

• a muscle-sparing approach and limited soft tissue trauma;

• the potential to reduce scarring through less tissue dissection.

BESS/UBE combines spinal canal decompression with minimally invasive access. The method may also be used for multilevel stenosis. If stabilization or deformity correction is needed, endoscopic decompression alone is insufficient.

References

1. Fehlings MG, et al. A clinical practice guideline for the management of patients with degenerative cervical myelopathy: recommendations for patients with mild, moderate, and severe disease and nonmyelopathic patients with evidence of cord compression. Global Spine Journal. 2017;7(3 Suppl):70S–83S.

2. Bajamal AH, et al. Posterior surgical techniques for cervical spondylotic myelopathy: WFNS Spine Committee recommendations. Neurospine. 2019;16(3):421–434.

3. Kim J, Heo DH, Lee DC, Chung HT. Biportal endoscopic unilateral laminotomy with bilateral decompression for the treatment of cervical spondylotic myelopathy. Acta Neurochirurgica. 2021;163(9):2537–2543.

4. Zhu C, et al. Unilateral biportal endoscopic laminectomy for treating cervical stenosis: a technical note and preliminary results. Medicina. 2023;59(2):305.

Previous chapter: 14. Cervical foraminal stenosis

Next section: Indications and contraindications

Contents