I am going to have surgery for a problem called cervical spondylotic myelopathy. They are going to cut away some of the bone in my spine to take the pressure off my spinal cord. The reason I have this problem is because the hole for the spinal cord is too small. What are my chances for a good recovery?
Cervical spondylotic myelopathy (CSM) is a neurologic problem that can cause pain, weakness, changes in bowel and bladder function, and difficulty walking or using the arms and hands. Cervical refers to the cervical spine or neck. Spondylotic means there is bone involvement. In the case of CSM, the vertebral bones with the opening for the spinal cord are the center of attention. Myelopathy tells us the spinal cord is affected.
Myelopathy can be caused by many different things. The most common is a narrowing of the spinal canal (opening for the spinal cord). Anything that causes this narrowing can put pressure on the spinal cord, resulting in neurologic deficits. This narrowing called spinal stenosis can occur as a result of bone spurs or thickening or hardening of the spinal ligament (posterior longitudinal ligament).
Tumors, infection, trauma, and age-related degenerative changes in the spine can also contribute to stenosis. With aging, the vertebral bodies compress and develop a lip around the edge. Even a small amount of lipping alters the position of the facet (spinal) joints.
At the same time, the intraforaminal space where the spinal nerve roots leave the spinal cord get compressed. Likewise, the discs between the vertebral bodies are under increased pressure. All of these factors together can create the CSM condition.
In your case, it sounds like the major cause of CSM is a congenital decrease in the size of the spinal canal. This occurs without an equal decrease in the size of the spinal cord going through the canal. The condition is referred to as developmental stenosis since it is present at birth.
A recent study of patients with CSM caused by developmental stenosis showed no difference in results of A recent study from Japan showed that results of surgery for patients with CSM were no different for patients with developmental stenosis compared with patients who did not have developmental stenosis. Recovery rates were the same for everyone no matter what gender (male or female) or age.
Some studies have shown a slower recovery rate for patients with the most narrow spinal canals. But surgeons can used a specific surgical technique to make more room for the spinal cord in such cases.
Neck motion was less in the group with developmental stenosis but this didn't appear to affect the final outcome. The loss of motion was attributed to stiffness around the joint as a result of the type of surgery performed.
You should talk with your surgeon about what to expect after surgery. Results can vary depending on the type and extent of surgery performed. There are always potential problems with any surgery. The possible complications will be explained to you before the operation. You should have a chance to ask questions during the pre-operative work-up. Use that opportunity to ask about recovery rates and postop rehab.
Hideki Shigematsu, MD, et al. Does Developmental Canal Stenosis Influence Surgical Results of Bilateral Open-Door Laminoplasty For Cervical Spondylotic Myelopathy? In Journal of Neurosurgery. October 2008. Vol. 9. No. 4. Pp. 358-362.
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