Cervical Spinal Stenosis

What happens in cervical stenosis

The spinal canal in the neck contains the spinal cord, and nerve roots leave through side openings called foramina. Narrowing can affect either:

• Foraminal stenosis: a nerve root is pinched, causing cervical radiculopathy.
• Central canal stenosis: the spinal cord is compressed, causing cervical myelopathy. This is the most important form because cord damage can be permanent.

A normal adult cervical canal is about 17 mm deep front to back. Under about 13 mm is considered narrow, and under about 10 mm is severe.

Causes

• Cervical spondylosis: age-related degeneration with disc bulging, bone spurs and thickening of the ligamentum flavum. The commonest cause, usually after age 50.
• Disc herniation
• Ossification of the posterior longitudinal ligament (OPLL): more common in people of East Asian descent
• Congenital narrow canal: makes symptoms more likely with smaller degenerative changes
• Spondylolisthesis (slippage) and instability
• Rheumatoid arthritis affecting the upper neck
• previous neck injury or surgery
• rarely tumors or infection

Symptoms

Nerve root compression (radiculopathy)

• neck pain
• sharp or burning pain radiating into the shoulder, arm or hand
• tingling or numbness in specific fingers
• weakness in specific muscles, such as grip or elbow straightening
• symptoms worse with turning or tilting the head

Spinal cord compression (myelopathy)

Myelopathy often develops slowly and painlessly, so it is easily missed:

• clumsy hands: trouble with buttons, writing, using keys or a phone
• numb, tingling hands in a "glove" pattern
• gait problems: unsteady, wide-based walking, frequent tripping
• leg stiffness and weakness
• electric-shock sensations with neck flexion (Lhermitte sign)
• urinary urgency or, later, incontinence

Severity

Diagnosis

• Neurological examination: strength, sensation, reflexes, gait, hand dexterity, and signs of cord compression such as brisk reflexes, Hoffmann sign and an upgoing big toe (Babinski sign).
• MRI: the key test, showing canal narrowing, cord compression and signal change within the cord.
• CT or CT myelogram: for bone detail and OPLL, or when MRI is not possible.
• X-rays, including flexion and extension views, for alignment and instability.
• Nerve conduction studies and EMG: to separate nerve root problems from peripheral nerve conditions like carpal tunnel syndrome.

Treatment

Non-surgical treatment

For radiculopathy, and sometimes for mild stable myelopathy:

• Physical therapy: neck and shoulder strengthening, posture work, nerve mobilization
• NSAIDs and short-term pain relief, following the label
• Neuropathic pain medicines in some cases
• Epidural steroid injections for arm pain from nerve root compression
• Activity modification: avoiding prolonged neck extension and high-risk activities
• A soft collar briefly for flare-ups, not long term

Most cases of cervical radiculopathy improve within weeks to months.

Surgery

Guidelines recommend surgery for moderate and severe myelopathy, and it should be offered for mild myelopathy. Surgery aims to stop progression; it may improve some symptoms but cannot always reverse damage. Options:

• Anterior cervical discectomy and fusion (ACDF): removes the disc and spurs from the front, then fuses the vertebrae.
• Cervical disc replacement in selected people.
• Laminoplasty: opens and widens the canal from the back while preserving motion.
• Laminectomy and fusion: removes the back of the vertebrae and stabilizes the spine.
• Foraminotomy: widens a single nerve opening for radiculopathy.

Complications

• permanent weakness, numbness and loss of hand function from untreated myelopathy
• falls
• spinal cord injury after minor trauma such as a fall, because a narrow canal leaves little room (central cord syndrome)
• surgical risks: swallowing difficulty, hoarseness, infection, adjacent segment degeneration

Outlook

Radiculopathy usually has a good outlook with non-surgical care. Myelopathy tends to progress gradually or stepwise. Earlier surgery, before severe deficits develop, gives better results.

Frequently asked questions

What are the symptoms of cervical stenosis?

Neck pain, and pain, tingling or weakness in one arm when nerve roots are pinched. When the spinal cord is compressed, symptoms include clumsy hands, numbness in both hands, unsteady walking, leg stiffness and sometimes bladder changes.

Is cervical stenosis serious?

It can be. Many people have mild narrowing without symptoms. Compression of the spinal cord (myelopathy) is serious because it can cause permanent loss of hand function and walking ability, and needs prompt specialist assessment.

Can cervical stenosis be treated without surgery?

Nerve root symptoms often improve with physical therapy, pain relief and sometimes injections. Spinal cord compression with progressive symptoms usually needs surgery, because non-surgical treatment does not relieve pressure on the cord.

What activities should I avoid with cervical stenosis?

People with significant canal narrowing are often advised to avoid contact sports, diving, heavy overhead lifting and activities with a high risk of falls or neck trauma. Your spine specialist can give individual advice based on your scans and symptoms.