From the Research
Flattening of the thecal sac in the cervical spine is a serious condition that requires prompt attention to prevent further compression of the spinal cord and nerve roots, and treatment should be guided by the most recent and highest quality evidence, such as the study by 1, which highlights the importance of considering the laxity of spinal cord suspension ligaments in patients with connective tissue disorders.
Causes and Symptoms
Flattening of the thecal sac in the cervical spine typically indicates spinal stenosis, which is a narrowing of the spinal canal that can compress the spinal cord and nerve roots. This condition often results from degenerative changes such as disc herniation, bone spurs, or ligament thickening. Symptoms may include neck pain, arm pain, numbness, tingling, or weakness.
Diagnostic Approach
The diagnostic approach to flattening of the thecal sac in the cervical spine should involve imaging studies such as CT or MRI to evaluate the extent of spinal stenosis and compression of the spinal cord and nerve roots. The study by 2 suggests that CT can be a useful tool in evaluating significant spinal stenosis and cauda equina impingement, with a high sensitivity and negative predictive value.
Treatment Options
Treatment depends on symptom severity but usually begins with conservative approaches, such as:
- Physical therapy focusing on neck strengthening and posture improvement
- Over-the-counter pain medications like ibuprofen (400-800mg three times daily) or naproxen (220-500mg twice daily)
- Prescription muscle relaxants such as cyclobenzaprine (5-10mg at bedtime) for muscle spasms
- Activity modification to avoid positions that worsen symptoms If conservative treatments fail after 6-12 weeks or if neurological symptoms like weakness or bladder/bowel dysfunction develop, surgical intervention may be necessary. Surgery typically involves decompression procedures to create more space for the spinal cord and nerves.
Recent Evidence
The study by 1 highlights the importance of considering the laxity of spinal cord suspension ligaments in patients with connective tissue disorders, such as hypermobile Ehlers-Danlos syndrome. This study suggests that pathological spinal cord motion is due to the laxity of such suspension bands, and that real-time ultrasound can be used to compare the spinal cord at C1-2 of patients with EDS with those of healthy control participants.
Key Points
- Flattening of the thecal sac in the cervical spine is a serious condition that requires prompt attention
- Treatment should be guided by the most recent and highest quality evidence
- Conservative approaches should be tried first, but surgical intervention may be necessary if symptoms persist or worsen
- The laxity of spinal cord suspension ligaments should be considered in patients with connective tissue disorders, such as hypermobile Ehlers-Danlos syndrome.