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By Kyle J. Norton
Health article writer and researcher; Over 10.000 articles and research
papers have been written and published on line, including world wide
health, ezine articles, article base, healthblogs, selfgrowth, best
before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by
Disilgold.com Named 50 of the best health Tweeters Canada - Huffington
Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as
international journal Pharma and Bio science, ISSN 0975-6299.
Cervical Stenosis with Myelopathy
Cervical Stenosis is condition of degeneration
of the structures of the spine as a result of aging. Spinal stenosis
causes pressure on the spinal cord, leading to the symptoms of
myelopathy. Cervical spinal stenosis with myelopathy is a common disease
in elderly patients of male gender(2).
A. Symptoms
Symptoms are as of result of neurologic disease which can lead to
progressive disability and eventual paralysis if without appropriate
treatment, depending to the expression of the exact distribution of the
myelopathy in the spinal cord. Most elders with Cervical Stenosis are
experience painless symptoms, others may be experience one of more
symptom, depending to the location of the compression and dysfunction of
spinal cord.
1. Increased knee and ankle reflex may be a first sign of the disease
2. Tightness of gait and numbness of the legs, depending to the
expression of the exact distribution of the myelopathy in the spinal
cord of the individual patient, such as weakness, difficulty walking,
frequent falls, etc.
3. Pins-and-needles (paraesthesia) sensation in the whole body.
4. Muscle weakness or paralysis
5. Deterioration in fine motor skills (such as handwriting or buttoning a shirt)
6. Intermittent shooting pains into the arms and legs (like an
electrical shock), especially when bending their head forward (known as
Lermitte’s phenomenon)
7. Arm and neck pain as a result of the
myelopathy constitute a combination of cord failure at the affected
level and of compression and irritation of the cervical nerve roots
which leave the neck at this site, such as weakness, stiffness or
clumsiness in the hands,
8. Loss of appreciation of temperature,
pain and joint sense and often with impairment of bladder and bowel
control, as a result of the transverse lesion of the spinal cord
effecting modalities of cord transmission with spasticity of gait and
increased tendon reflexes, in the later state of (3).
9. Etc.
B. Causes of risk factors
B.1. Causes
Cervical
Stenosis with myelopathy may be result of degenerative changes within
the spine or bone spurs, due to genetics, and wear and tear of daily
living, causing the size of the spinal canal becoming smaller and bone
spurs pressing on the spinal cord or the nerve roots. Tumor located
between the spinal cord and vertebrae can cause Cervical Stenosis with
Myelopathy.
B.2. Risk factors
1. Aging and gender
If you are male and over 50 years of age(3a), you are at higher risk to develop Cervical Stenosis with Myelopathy.
2. Genetics
Congenital narrowing of the cervical spinal
canal may result in cord compression without a history of injury
and evidence of significant bony degenerative changes(4).
3. Wear and tear of daily living
Tear and wear,
injure cause of scar tissues and weaken the function of disc in
absorbing shock(4a), may induce pressure on the spinal cord.
4. Injure(4a)
Injure to the spine can cause scar tissues, leading weaken the spinal tissues, such as thickened ligaments.
5. Etc.
C. Complications
1. Numbness and paresis
Patient with similar cervical spinal cord injury in the past may develop transient numbness and paresis of of the lower limbs(5).
2. Incontinence
Degenerative spinal disease can result
in acute or chronic urinary incontinence, depending to gender, BMI,
radicular weakness and the type of degenerative disease. Surgical
treatment showed to improve or eliminate the symptoms of urinary
incontinence in more than half of the patients affected(6).
4. Paralysis
Cervical stenosis can cause increased risk
of paralysis(7a), depending on where the spinal cord and nerve roots
are damaged by Cervical Stenosis.
5. Chronic pelvic pain and infertility
Cervical stenosis
condition often recurs despite intervention. women who encounter
ecurrent stenosis are at risk of developing severe complications such
as chronic pelvic pain and infertility(7).
6. Etc.
D. Diagnosis
The aim of the diagnosis is to find the causes of the pain. After a
complete history and physical exam, the tests your doctor ordered may
include
1. X ray
X ray may be the first examination ordered by your doctor to detect the presence of Cervical Stenosis.
2. Computed Tomography (CT) Scan
A CT scan generates a
large series of two-dimensional X-ray images taken around a single axis
of rotation, to create a three-dimensional picture of the inside of the
body in details.The pictures are viewed by your doctor to see the
extent of the Cervical Stenosis.
3. Magnetic Resonance Imaging (MRI)
MRI (magnetic
resonance imaging) is one of many advanced technology used to visualize
internal structures cross sectional imaging of your body used
effectively in providing the better details of the Cervical Stenosis
and surrounding areas.
4. Myelogram
Myelogram is an X-ray of your spine taken
with a injection of special dye into the spinal column for your doctor
to examine the pressure on the spinal cord or problems with discs or
vertebrae or tumor between the spinal cord and vertebrae.
5. Etc.
E. Cervical Stenosis with Myelopathy Prevention
E.1. The do’s and do not’s list
1. Maintain a healthy weight
Lose weight if you are over weight or obesity, excess weight places
more pressure on the spinal column and especially on the intervertebral
discs, leading to congenitally narrow canal risk of developing
cervical spinal stenosis, according to University of California at Los
Angeles.
2. Exercise(8a)
Regular morderate exercise such as
aerobics, strength and flexibility exercises, aerobic exercises not
only help to slow the rate of age degeneration, but also enhance the
general fitness of the whole body, including exercises to strengthen
your back, legs and arms as well as keeping your abdomen strong
therefore offering more support for your back.
3. Quit smoking
Smoking can increase the risk of free
radical attacks of which can cause early aging and aging effects.
According to the theory of free radicals “A free radical is any atom or
molecule that has a single unpaired electron in an outer shell and
highly reactive to react with other cell, which in turn, causes
oxidative damage to the enzymes, other protein, unsaturated fatty acid,
phospho-lipids, DNA and RNA, etc., leading to aging of the organisms,
as a result of widespread damage due to set of a chain reaction
auto-catalytically after attacking the lipid bilayers of the cell
walls”(8).
4. Eating healthy
Eating healthy can not only reduce the progression of aging(8b) but also the risk of diseases that cause Cervical Stenosis
5. Etc.
E.2. The Diet
Healthy foods maintain a healthy weight, enhance immune system, delay aging can reduce the risk of Cervical Stenosis.
1. Green tea
EGCG, found abundantly in green tea significant enhance
longevity-extending effects, through its free radical-scavenging
effects and up-regulating effects on stress-resistance-related
proteins, including superoxide dismutase-3 (SOD-3) in vitro and in
vivo, according to Chinese Academy of Science, showed that the
survival-enhancing effects of EGCG on C. elegans under stress are very
important(9).
2. Avocados
Methanolic (80%) extracts obtained from
lyophilized ground peels and seeds of avocado (Persea americana Mill.)
of the Hass and Shepard varieties exhibit theirs antioxidant activity
in does of 0.16 and 0.47 mmol Trolox/g(10).
3. Skin and seed of grape
Resveratrol found abundantly
in grape skins and seeds possesses diverse biochemical and
physiological properties including anti-inflammatory and
immunomulatory, antiaging properties, etc.(11).
4. Organic soy
Isoflavones, a major phytochemical found
in soy demonstrated the antioxidant effect against in rats with
myocardial infarction (MI), through increased activity of antioxidant
enzyme activity and nitrite/nitrate content(12).
5. Turmeric
Curcumin treatment of both 6 and 24 months
old rats demonstrated the antioxidative, antilipofusinogenesic and
anti-ageing effects of curcumin in the brain, according to the study of
Jawaharlal Nehru University(13).
6. Etc.
E.3. Antioxidants to prevent Cervical Stenosis(13)
Antioxidants are proven to be effective to enhance the immune system in
fighting against the forming of free radicals causes of irregular cell
growth and the progression of early aging.
1. Bilirubin
Bilirubin, a cellular antioxidant with function in breaking down
molecules into smaller units in releasing energy and excreting in bile
and urine, when oxidized that inhibits the effects of mutagens.
2. Carotenoids
Carotenoids are organic pigments,
occurring in the chloroplasts and chromoplasts of plants and some other
photosynthetic organisms like algae, some bacteria.
a. Beta-carotene
Beta-Carotene, an organic compound and classified as a terpenoid, a strongly-coloured red-orange pigment in plants and fruits.
a.1. Stored in liver for the production of vitamin A has shown
to inhibits cancer cell in experiment. Beta-carotene also neutralize
singlet oxygen before giving rise of free radicals which can damage of
DNA cause of improper cell DNA replication.
a.2. Cell communication
Beta-carotene enhances the communication between cell can reduce the risk of cancer by making cells division more reliable.
a.3. Immune system
Beta-carotene promotes the immune system in identifying the foreign
invasion such as virus and bacteria by maintaining optimal function of
white cells.
a.4. Polyunsaturated fat
Beta-carotene also
inhibits the oxidation of polyunsaturated fat and lipoprotein in the
blood that reduce the risk of plaques building up onto the arterial
walls cause of heart diseases and stroke.
a.5. There are more benefits of beta-carotene.
b. Alpha-carotene
Alpha-carotene, one of the most
abundant carotenoids in the North American diet, not only protects
cells from the damaging effects of free radicals and enhances the
immune system in fighting against bacteria and virus invasion, but also
stimulates the communication between cells thus preventing irregular
cell growth cause of cancers.
c. Beta-cryptoxanthin
Beta cryptoxanthin, an
antioxidant, beside preventing free radical damage to cells, it also
stimulates the repair of oxidative damage to DNA and enhances the
immune function infighting against inflammatory cause of polyarthritis,
and irregular cell growth.
d. Lutein
Lutein found in greens like kale and
spinach and yolk of eggs, reduces risk of age related macular
degeneration, an eye condition.
Lutein deficiency may induce a cellular antioxidant related macular degeneration, leading blindness.
e. Zeaxanthin
Zeaxanthin, a most common
carotenoid alcohols found in nature, showed to lower the risk oxidative
stress cause of incidence of age-related macular degeneration.
f. Lycopene
Lycopene, one of the most powerful
antioxidants in the carotenoid group found in tomatoes, watermelons,
and grapefruits, consists many anti-aging capabilities.
3. Flavonoids
Flavonoids, the yellow pigments having a
structure similar to that of flavones occurred in varies plants,
process a property as antioxidants. it helps to neutralize many of
reactive oxygen species (ROS), including singlet oxygen, hydroxyl and
superoxide radicals.
a. Quercetin
Quercetin, a
plant-derived flavonoid found in fruits, vegetables, leaves and
grains reduces the risks of free radical causes of damage cell
membranes, mutation of cells with tampering DNA, through its consists
anti-inflammatory, antioxidant properties.
b. Rutin
Rutin, a citrus flavonoid glycoside found in
buckwheat and glycoside of the flavonoid quercetin, inhibits platelet
aggregation, decreases the capillary permeability and reduce the risk
of free radicals induced cytotoxicity of oxidized LDL cholesterol.
c. Catechin
Catechin is a natural phenol antioxidant
plant and natural anti-bacterial substance exhibits it free radical
scavenging power in inhibition of ROS production.
d. Etc.
F. Treatments
F.1. In conventional Medicine perspective
I. Non surgical treatments
1.1. Wait and watch
Wait
and watch may be necessary if patients are experience no symptom and
abnormalities to prevent diagnosis with the diseases some time in the
future.
1.2. Medication
Certain medication such as non-steroidal
anti-inflammatory drugs (NSAIDs), oral steroids, or injected steroids
such as epidural steroid injections and nerve root injections may be
helpful in relieving pain and alleviating symptoms temporary of the
patients with no intention to correct any abnormalities or
misalignment.
1.3. Physical therapy or exercise
Physical exercise such as stretching may be helpful to restore the flexibility of tight muscles
as well as enhancing the neck mobility, muscular strength and spinal
balance. Other exercise, including Cardiovascular exercises for arms and
legs also for promotion of blood circulation.
1.4. Etc.
2. Surgical treatments
Surgical treatments may be
necessary if patients are experience the symptoms of increasing
weakness, pain or inability to walk, etc. depending to differentiation
2.1. Anterior Surgery
Cervical Discectomy and Fusion (ACDF)
The aim of the surgery is to relieve pressure from the spinal cord and
compression of the spinal. Anterior Cervical Discectomy and Fusion
(ACDF) is the operation done from the front of the neck to remove the
disc above and below the vertebra and replace it with a small plug of
bone. If more than one level of the spine is involved. Cervical Spinal
Fusion may be necessary by implanting a bone graft between cervical
segments to support the spine as to compensate for the removal of bone
and discs.
2.2. Posterior surgery
a. Laminectomy and Fusion
The
aim of the surgery is also to relieve the pressure and to create more
space for the nerves. In Laminectomy and Fusion, the lamina is removed
and two or more vertebral segments of the cervical spine are fused
together.
b. Laminoplasty
In case of Laminoplasty, only a small
section of the bony roof of the spine, the lamina, is removed instead
of removal of the lamina to expand the spinal canal with an aim to
create a space for the the spinal cord.
2.3. Etc.
F.2. In herbal medicine perspective
The aim of herbal medicine is to relieve symptoms of Cervical Stenosis
1. Cayenne
Cayenne used in traditional medicine to increases metabolism,
enhance circulatory system and stomach and the intestinal tract, adjust
blood pressure, lower LDL cholesterol and triglycerides, treat
frostbite, muscles, arthritis, rheumatism, low back pain, strains,
sprains, bruises and neuralgia, etc., also known as Cayenne Pepper, is a
red, hot chili pepper, belonging to Capsicum annuum, the family
Solanaceae, native to sub-tropical and tropical regions.
According to the 1Provincal
Medical Centre in Ontario, in a randomized controlled trials, examining
adults (over 18 years of age) suffering from acute, sub-acute or
chronic non-specific low-back pain, cayenne showed to inhibit pain and improve quality of life for patients with chronic low-back pain(a)
2. Valerian
Valerian, used as a sedative and relaxing agent and to treat the
liver, the urinary tract, the digestive tract problem, nerve
conditions, etc.is a perennial flowering plant, in the genus Valeriana,
belonging to the family Valerianaceae, native to Europe and parts of
Asia.
Essential oil (VPAEO) from Valerian on experimental models showed to exerted its peripheral analgesic effects via inhibition of prostaglandin synthesis(b).
3. Etc.
F.3. In Traditional Chinese medicine perspective1. Compound Qishe Tablets, Jingfukang, Extractum Nucis Vomicae, etc.
According
to to randomized controlled trials with adults with a clinical
diagnosis of cervical degenerative disc disease, cervical radiculopathy
or myelopathy supported by appropriate radiological findings.
1. Compound Qishe Tablets showed to relieve pain better in the short-term than either placebo or Jingfukang.
2. Oral herbal formula of Huangqi ((Radix Astragali)18 g, Dangshen
(Radix Codonopsis) 9 g, Sanqi (Radix Notoginseng) 9 g, Chuanxiong
(Rhizoma Chuanxiong)12 g, Lujiao (Cornu Cervi Pantotrichum) 12 g, and
Zhimu (Rhizoma Anemarrhenae)12 g) relieved pain better than Mobicox or
Methycobal
3. Compound Extractum Nucis Vomicae, relieved pain better than Diclofenac Diethylamine Emulgel.(14)
2. Acupuncture
According to the study of Neurochirurgischen Abteilung des
Landeskrankenhauses Feldkirch, the treatment of chronic spinal pain is
dominated by non-operative procedures. Acupuncture does not only serve
as treatment option for pain relief, but also and even more so has an
harmonizing effect upon physical and psychological disturbances(15).
3. Etc.
Reprinted from Norton Journal, Volume
I, Most Common Diseases of Ages of 50 Plus - Chapter of Musculoskeletal disorders (MSDs): Cervical Stenosis with Myelopathy by Kyle J. Norton
References
(1) http://www.ncbi.nlm.nih.gov/pubmed/7864688
(2) http://www.ncbi.nlm.nih.gov/pubmed/22426774
(3) http://www.saspine.org/conditions/cervical_spinal_stenosis_myelopathy.htm
(3a) http://www.ncbi.nlm.nih.gov/pubmed/19333104
(3b) http://www.ncbi.nlm.nih.gov/pubmed/24870121
(4) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC492191/
(4a) http://www.ncbi.nlm.nih.gov/pubmed/?term=Wear+and+tear+Cervical+Stenosis+with+Myelopathy
(5) http://www.ncbi.nlm.nih.gov/pubmed/11985781
(6) http://www.ncbi.nlm.nih.gov/pubmed/21375969
(7a) http://www.ncbi.nlm.nih.gov/pubmed/15658120
(7) http://www.ncbi.nlm.nih.gov/pubmed/22711046
(8) http://medicaladvisorjournals.blogspot.ca/2012/01/antioxidants-and-theories-of-aging.html
(8a) http://www.ncbi.nlm.nih.gov/pubmed/24139010
(8b) http://www.ncbi.nlm.nih.gov/pubmed/16470005
(9) http://www.ncbi.nlm.nih.gov/pubmed/19061950
(10) http://www.ncbi.nlm.nih.gov/pubmed/22494370
(11) http://www.ncbi.nlm.nih.gov/pubmed/20623511
(12) http://www.ncbi.nlm.nih.gov/pubmed/22808939
(13) http://medicaladvisorjournals.blogspot.ca/2012/01/antioxidants-and-common-free-radical.html
(a) http://www.ncbi.nlm.nih.gov/pubmed/16625605
(b) http://www.ncbi.nlm.nih.gov/pubmed/21046983
(c) http://www.ncbi.nlm.nih.gov/pubmed/17202897
(14) http://www.ncbi.nlm.nih.gov/pubmed/20091597
(15) http://www.ncbi.nlm.nih.gov/pubmed/11075429
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