Cervical spinal stenosis is narrowing of the spinal canal in the neck. The narrowing squeezes (compresses) the nerves and sometimes the spinal cord causing neck pain and sometimes weakness and abnormal sensations in the arms or legs.
Osteoarthritis, disc bulges and herniations, and spondylolisthesis can cause narrowing of the spinal canal.
Symptoms, if present, can include neck pain; tingling in the arm, hand, leg, or foot; and weakness and loss of balance.
The diagnosis is based on a doctor's evaluation and the results of imaging or electrodiagnostic tests.
Treatment includes measures to relieve pain and sometimes surgery.
The spinal canal runs through the center of the spine and contains the spinal cord and the bundle of nerves that extends downward from the bottom of the spinal cord in the lower back.
Along the length of the spinal cord are the spinal nerves. The spinal nerves emerge from the sides through spaces between the vertebrae to connect with nerves throughout the body. The part of the spinal nerve nearest the spinal cord is called the spinal nerve root. Because of their location, spinal nerve roots can be squeezed when the spinal canal is narrowed, resulting in pain.
The most common causes of cervical spinal stenosis include osteoarthritis, disc degeneration, and spondylolisthesis. Other causes include ossification of the posterior longitudinal ligament, ankylosing spondylitis, and Paget disease of bone.
The Spine
A column of bones called vertebrae make up the spine (spinal column). The vertebrae protect the spinal cord (a long, fragile structure contained in the spinal canal), which runs through the center of the spine. Between the vertebrae are discs composed of cartilage, which help cushion the spine and give it some flexibility. Spinal nerves: Emerging from the spinal cord between the vertebrae are 31 pairs of spinal nerves. Each nerve emerges in two short branches (roots)—motor and sensory—which join to form a spinal nerve. The motor roots carry commands from the brain and spinal cord to other parts of the body, particularly to skeletal muscles. The sensory roots carry information to the brain from other parts of the body. Cauda equina: The spinal cord ends about three fourths of the way down the spine, but a bundle of nerves extends beyond the cord. This bundle is called the cauda equina because it resembles a horse's tail. The cauda equina carries nerve impulses to and from the legs, lower intestine, and bladder. |
Symptoms of Cervical Spinal Stenosis
Some people with cervical spinal stenosis do not have symptoms.
Other people have neck pain and limited range of neck motion. Symptoms of spinal cord compression include numbness or tingling in the arm, hand, leg or foot, weakness, or a loss of balance.
Diagnosis of Cervical Spinal Stenosis
A doctor's evaluation
Imaging tests, electrodiagnostic studies, or both
Doctors typically suspect the diagnosis of cervical spinal stenosis based on the person's symptoms and physical examination. During a physical examination, doctors check a person's strength and reflexes.
Doctors do other tests to make the diagnosis if people have weakness or numbness or if their symptoms have lasted for more than 6 weeks. Magnetic resonance imaging (MRI) and computed tomography (CT) are imaging tests that can help doctors identify abnormalities of the spine that are causing cervical spinal stenosis. Tests of the nerves and muscles (electrodiagnostic tests), such as nerve conduction studies and electromyography, can help doctors identify the affected area of stenosis and the severity of the damage.
Treatment of Cervical Spinal Stenosis
Measures to relieve pain
Sometimes surgery for severe pain
Measures to relieve pain
Applying cold (such as ice packs) or heat
People should sleep on their back with a thin pillow under the neck to keep the cervical spine aligned.
Physical therapy may help relieve symptoms. Physical therapy focuses on posture, motion, and strength of the muscles around the neck to relieve symptoms.
Surgery
When measures to relieve pain are not effective in people with cervical stenosis or there are changes in the spinal cord due to compression, surgery may be needed to relieve pressure on the spinal cord and spinal nerves.
The most common approach is a cervical decompression from the front (anterior) combined with a removal of the disc and fusion. One surgical procedure is called a cervical laminectomy, in which a portion of the vertebrae called the lamina is removed, taking pressure off the spinal cord and spinal nerves. Laminectomy of the cervical spine is almost always includes attachment of adjacent vertebrae (fusion) to avoid a common consequence of abnormal curvature of the spine in the neck (cervical kyphosis).
