Question:I have pressure on my spinal cord in the neck from a condition called stenosis. Based on my MRI results, the doctor is recommending surgery. My symptoms aren't really that bad. Should I go with the test results or by how I feel when deciding what to do?
Answer:Pressure on the spinal cord in the cervical (neck) spine is called cervical myelopathy (CM). A common cause of CM in older adults is spinal stenosis.
Stenosis is a narrowing of the spinal canal. The spinal cord is inside the spinal canal, where the surrounding bone protects it. Anything that narrows the spinal canal can put pressure on the cord causing neck and/or arm pain, numbness, and weakness.
With improved technology, MRIs have become very useful. MRIs can show how much stenosis is there. Change in the MRI signal is a sign of spinal cord lesions. The change could be an increased or decreased signal intensity. An increased signal intensity is more likely in patients with cervical compression myelopathy.
Many doctors advise their patients with early signs of spinal stenosis to try conservative therapy first before surgery. This may include pain relievers, antiinflammatories, and physical therapy. If the symptoms persist or get worse after nonoperative care, then surgery may be the next step.
A recent study looking at MRIs taken before surgery and compared to results after surgery offered some useful information. The study showed that older patients who wait too long have the worst results after surgery.
Age and duration of symptoms are important to consider. It looks like patients with MRI changes but mild or no neurologic symptoms may be the best ones to have the surgery sooner than later. Overall results are better and the risk of neurologic disability is less.Yasutsugu Yukawa, MD, et al. MR T2 Image Classification in Cervical Compression Myelopathy. In Spine. July 1, 2007. Vol. 32. No. 15. Pp. 1675-1678.
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