On World Spine Day, October 16, we are focusing on an often-unrecognized condition: cervical spinal stenosis. If left untreated, it can lead to severe neurological damage. Today's awareness day is intended to help sensitize both those affected and doctors to the specific warning signs, enabling earlier diagnosis.
With the increasing aging of the population, the number of patients suffering from cervical spinal stenosis is also on the rise. This degenerative disease is caused by wear and tear of the spine, which narrows the spinal canal and can put pressure on the spinal cord and nerves. This can cause pain, paralysis and, if left untreated, permanent nerve and spinal cord damage. However, the symptoms are often mistaken for normal age-related complaints.
We spoke with Dr. Ralph Schär, MD, who is a senior physician at the Department of Neurosurgery at Inselspital, Bern University Hospital. He specializes in the surgical treatment of complex spinal disorders.
Dr. Schär, what are the typical symptoms of cervical spinal stenosis?
«One of the main symptoms is an unsteady gait – sufferers often walk stiffly and are therefore at increased risk of falling and injuring themselves. Bladder function can also be affected, as the nerves responsible for this pass through the cervical spinal cord. Other typical symptoms include numbness and clumsiness in the hands.»
And why is cervical spinal stenosis often not diagnosed correctly?
«Although cervical spinal stenosis is a relatively common condition, especially among older people, it is unfortunately often diagnosed late. The symptoms are often mistakenly dismissed as general signs of aging. Complaints such as an unsteady gait, clumsiness of the hands or bladder dysfunction with incontinence are quickly dismissed as 'just part of getting older'. Cervical spinal stenosis is also often painless, which makes diagnosis even more difficult.
It is only when the patient is examined more closely and an MRI is performed that it becomes clear that the spinal cord is compressed by the stenosis in the cervical spine. It is truly alarming how often this occurs – and yet cervical spinal stenosis can be treated well with surgery today.»
Why is it important to make the diagnosis early?
«In the area of the cervical spine, the spinal cord has little room to move when compressed, which can lead to serious deficits affecting both arms and legs. As a result, the damage is significantly more severe than with a stenosis of the lumbar spine, and the quality of life of those affected is more significantly reduced.
If the symptoms have already become chronic, the nerve damage in the cervical spine often recovers only partially. Therefore, early diagnosis and intervention for cervical stenosis is crucial to better control the condition.
Recent international studies based on large data sets also show that the quality of life and the functions of those affected improve noticeably after a successful surgery.»
Are there also conservative treatment options for cervical spinal stenosis?
«Very limited, because it is a mechanical problem.»
This cervical spine stenosis mainly affects older people. Is it even possible to have this operation in old age?
«As a rule, age is not too important. More important are the patient's general state of health, existing pre-existing conditions and the risk of anesthesia. At Inselspital, we also offer this surgery to patients who are well over 80 years old – depending, of course, on the individual level of suffering, the specific pathology and the surgical technique chosen. We are very proactive and address the situation of each individual patient in a targeted manner.»
How is cervical spinal stenosis operated on?
«As is so often the case, there are various techniques. The big debate in cervical spinal stenosis is whether it is better to operate from the front or from behind. However, this is always a very individual decision based on the patient's anatomy – and, of course, on the surgeon's experience. Both approaches have their advantages and disadvantages, and we choose the best way depending on what makes the most sense for the person concerned.»
What complications can occur during the operation?
«The risk of complications with this operation is very low. Most patients may experience mild swallowing difficulties for a few days or a temporary hoarseness caused by the anterior approach. If the operation is performed from behind, the wound may be a little more painful. However, spinal cord injuries are an absolute rarity with this procedure.»
How long will the hospital stay be?
«The hospital stay is usually quite short, especially for patients who have been operated on from the front – we are talking about about 3 days. If you have surgery from behind, which can lead to more severe postoperative pain, you may sometimes have to stay an extra day or two. But overall, the stay is usually short.»
Does the hospital stay follow a rehab?
«It depends on how restricted the patients were before the operation. If there were already signs of paralysis, we usually recommend inpatient rehabilitation after the operation. Otherwise, most patients can go home immediately and only need outpatient physiotherapy, which is sufficient in the majority of cases.»
Is cervical spine stenosis caused by wear and tear of the spine? How likely is it that the symptoms will recur in a different location?
«That is a good question and has been the subject of intense discussion for a long time. This is referred to as the so-called degeneration of the connection. If, for example, we fuse two or three adjacent cervical vertebrae during an operation, the load on the adjacent, still mobile segments increases. These can then wear out more quickly. According to estimates, this symptomatic secondary degeneration affects about 3% of operated cases per year, or about one in four people after ten years.»
Are there preventive measures that can be taken to avoid stenosis?
«Unfortunately, genetic predisposition is a major factor – stenoses often run in families, and of course we can't influence that. The factors that can be influenced, however, are a healthy lifestyle, especially avoiding nicotine. This is extremely important in spinal surgery because smoking worsens bone quality and impairs blood flow to the spinal cord.
Likewise, a healthy posture plays an important role, especially for people who work a lot at a computer in an office. An ergonomic sitting position, with the monitor at eye level, is crucial here. And constantly looking down at a cell phone or tablet is also not good for the cervical spine.»
Are there also new developments and research results for cervical spinal stenosis?
«Yes, a lot has happened in recent years. In the past, the focus was mainly on disc prostheses, i.e. on motion-preserving surgery. Now, screws can be inserted minimally invasively and with the help of navigation systems in cases of stiffening of the cervical vertebrae. However, the current trend is also moving in the direction of robotics. This is a very challenging field because the anatomy of the cervical spine is smaller and more delicate than that of the thoracic or lumbar spine, and many sensitive structures such as blood vessels, the spinal cord and nerves are located here. That's why we're not making as much progress as we would like in this area. But there is still a lot of potential for further developments.»
World Spine Day
World Spine Day (#worldspineday) takes place every year on October 16. It is considered the largest international initiative to raise awareness of the increasing burden of spinal disorders. The day provides an important platform for informing people about prevention options and modern treatment methods, such as minimally invasive procedures. With timely therapies, the quality of life of many sufferers can be significantly improved.