Cervical spinal stenosis is narrowing of the cervical spinal canal causing compression of the nerve roots before their exit from the foramina. It can cause positional neck pain, symptoms of nerve root compression in the foramina, and upper-extremity pain.
(See also Evaluation of Neck and Back Pain.)
Cervical spine stenosis can be congenital or acquired. The most common causes are osteoarthritis, degenerative disc disorders, spondylosis, and spondylolisthesis with compression of the spinal cord. Other causes include Paget disease of bone and ankylosing spondylitis.
Symptoms and Signs of Cervical Spinal Stenosis
Cervical spinal stenosis can be asymptomatic or present with neck pain, restricted range of movement, and signs and symptoms of spinal cord compression (myelopathy) with loss of balance and weakness and spasticity in the upper and lower extremities.
If there is concomitant impingement on cervical roots, patients may experience paresthesias and weakness in the affected nerve root distribution at the level of the stenosis. Cervical radiculopathies are often associated with central stenosis at the level of stenosis (C5-C6 stenosis with a unilateral or bilateral C6 radiculopathy). The cervical canal is wider during flexion and narrower in extension; thus, radicular symptoms may be exacerbated during extension.
Diagnosis of Cervical Spinal Stenosis
Clinical evaluation
Sometimes MRI, electrodiagnostic studies, or both
Cervical spinal stenosis is suspected based on characteristic symptoms. Difficulty with fine motor skills in the upper extremities and weakness, ataxia, and spasticity in the lower extremities may be present. Deep tendon reflexes are hyperactive in the lower extremities but may be hypoactive in the upper extremities, with paresthesias and weakness in the upper extremities if there is coexisting nerve root impingement.
MRI is done to determine the level of stenosis and cause. Electrodiagnostic studies help differentiate cervical spinal stenosis from other neurologic conditions.
Treatment of Cervical Spinal Stenosis
Activity as tolerated
Analgesics
Physical therapy
Surgery for severe cases
In patients with cervical spinal stenosis, conservative measures constitute first-line treatment. These include analgesics and activity as tolerated. Physical therapy can help to relieve pain and muscle tightness and improve range of motion.
For advanced spinal stenosis, surgery involves decompression of the disc and bone compression of the spinal cord, either from an anterior or posterior approach in conjunction with fusion of the affected levels. Surgery can prevent further symptoms, but does not always reverse the myelopathic deficits (1, 2).
Treatment references
1. Wilson JR, Barry S, Fischer DJ, et al. Frequency, timing, and predictors of neurological dysfunction in the nonmyelopathic patient with cervical spinal cord compression, canal stenosis, and/or ossification of the posterior longitudinal ligament. Spine (Phila Pa 1976). 2013, 38(22 Suppl 1):S37-S54. doi:10.1097/BRS.0b013e3182a7f2e7
2. Badhiwala JH, Wilson JR. The natural history of degenerative cervical myelopathy. Neurosurg Clin N Am. 29(1):21-32, 2018. doi:10.1016/j.nec.2017.09.002
Key Points
Cervical spinal stenosis is narrowing of the cervical spinal canal causing compression of the structures of the cervical spine. When severe, the spinal cord can be compressed and cause symptoms in the upper and lower limbs.
It can be asymptomatic or present with neck pain, restricted range of movement, and signs and symptoms of spinal cord compression (myelopathy) with loss of balance and weakness and spasticity in the upper and lower extremities.
Patients may experience paresthesias and weakness in the affected nerve root distribution at the level of the stenosis if there is concomitant impingement on cervical roots as they exit from the cervical canal.
Diagnose based on characteristic symptoms along with MRI, electrodiagnostic studies, or both.
Recommend analgesics, light activity as tolerated, and physical therapy; however, if pain or deficits are severe or worsening, consider surgical procedures.
