What is cervical spinal stenosis?

Cervical spinal stenosis is where the spinal canal narrows in your neck.

The spinal cord passes down the spinal canal from your brain. Nerves from your spinal cord and blood vessels that supply the nerves pass into the spinal canal within the vertebrae.

The spinal canal tends to narrow as we get older caused by bony overgrowth from wear and tear in the facet joints, thickening of surrounding ligaments and bulging of the discs. A narrowed spinal canal in your neck can press on your spinal cord, preventing it from working properly.

What are the benefits of surgery?

The aim is to prevent further damage to your spinal cord. Surgery cannot repair damage to your spinal cord but your symptoms may improve.

Are there any alternatives to surgery?

If your symptoms are mild, you may not need any treatment. If your symptoms are severe or are getting worse, surgery is usually the only option.

What will happen if I decide not to have the operation?

Your symptoms are unlikely to improve. In 3 in 4 people, symptoms get significantly worse over time. Sometimes this can happen quickly and you may need an urgent operation.

What does the operation involve?

The operation is usually performed under a general anaesthetic but various anaesthetic techniques are possible. The operation usually takes 1 to 2 hours.

Your surgeon will make a cut on the centre of the back of your neck. They will part the muscles to get to your spine.

Your surgeon will remove enough bone and ligament tissue to open up the narrowed part of the canal, giving the spinal cord and blood vessels more room.

How can I prepare myself for the operation?

If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health. Nicotine is known to prevent wounds from healing properly following neck surgery, and increases the risk of unsightly scarring and chronic pain.

Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight.

Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health. Before you start exercising, ask the healthcare team or your GP for advice.

Speak to the healthcare team about any vaccinations you might need to reduce your risk of serious illness while you recover. When you come into hospital, practise hand washing and wear a face covering when asked.

What complications can happen?

The healthcare team will try to reduce the risk of complications.

Any numbers which relate to risk are from studies of people who have had this operation. Your doctor may be able to tell you if the risk of a complication is higher or lower for you. Some risks are higher if you are older, obese, you are a smoker or have other health problems. These health problems include diabetes, heart disease or lung disease.

Some complications can be serious and may even cause death.

General complications of any operation

• Bleeding during or after the operation. This can cause pressure on your spinal cord (extradural haematoma).
• Infection of the surgical site (wound).
• Allergic reaction to the equipment, materials or medication.
• Difficulty passing urine. You may need a catheter (tube) in your bladder for 1 to 2 days.
• Venous thromboembolism (VTE) — this is a blood clot in your leg (deep-vein thrombosis - DVT) or one that has moved to your lung (pulmonary embolus).
• Chest infection — you may need antibiotics and physiotherapy. Your risk will be lower if you have stopped smoking and you are free of Covid-19 (coronavirus) symptoms for at least 7 weeks before the operation.
• Heart attack or stroke. Sometimes a heart attack or stroke can cause death.

Specific complications of this operation

• Neuropathic pain. This is a burning pain that may happen once the pressure on the nerves has been released.
• Injury to your spinal cord and nerves. If the damage is severe, you can have problems controlling your bowel and bladder, or paralysis of your arms or legs.
• Infection in your spine. You will usually need another operation to clean out the infection.
• Damage to the nerve roots. You may get weakness in the muscles around your shoulder or changes in feeling in your arms.
• Tear of the thin membrane that covers the nerves in your spine (dural tear).
• Spinal instability, where there is too much movement between the vertebrae.

Consequences of this procedure

• Pain.
• Unsightly scarring of your skin.

How soon will I recover?

Keep your wound dry for 10 days.

You should be able to go home after 2 to 3 days.

Do not lift anything heavy or twist your body. Make sure you keep a good posture when sitting and walking.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.

Most people make a good recovery from surgery.

Summary

Cervical spinal stenosis is where the spinal canal narrows in your neck, causing weakness or numbness in your arms and legs. The aim of surgery is to prevent further damage to your spinal cord.

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