Cervical Stenosis
Cervical spinal stenosis is a common cause of neck pain, especially in adults 50 years of age or older. The term stenosis, which means narrowing, helps to explain how spinal nerves or the spinal cord in the neck can be compressed (pinched).
Types of cervical spinal stenosis
Foraminal spinal stenosis occurs when something compresses a nerve exiting the spinal column through the neuroforamen. Neuroforamen are naturally created pathways at the left and right sides between two vertebrae.
Central canal stenosis occurs when something compresses the spinal cord.
Some patients may develop both types of cervical spinal stenosis.
Causes
Although some people are born with spinal stenosis (called congenital spinal stenosis), most cases are in patients over age 50. Stenosis may progress incidental to naturally growing older and spinal wear and tear.
Some patients have a history of neck injury or trauma. The accident may have happened months or years before the onset of stenotic symptoms.
Different disorders can cause nerve or spinal cord compression, such as:
- Bony overgrowths called osteophytes
- Bulging or herniated discs
- Degenerative disc disease
- Thickening of spinal ligaments
Pain and other symptoms
Some people have no symptoms; they are asymptomatic. However, cervical spinal stenosis usually is progressive, which means symptoms eventually develop and may worsen over time. Pain may be primarily felt in the neck. It is common for pain to travel or radiate into one or both upper shoulders, arms, and/or hands. This is radicular pain or radiculopathy.
- Neck pain, mild to intense
- Upper extremity pain, weakness
- Sensations: burning, tingling, numbness, pins and needles
- Hand clumsiness
- Gait and balance disturbances
- In severe cases, bladder and bowel dysfunction
- Although rare, severe cases can cause loss of function or paraplegia
Myelopathy may develop with cervical spinal stenosis. Myelopathy is spinal cord dysfunction caused when the spinal cord becomes compressed. Myelopathy can develop gradually or suddenly, such as following trauma. Typical myelopathy symptoms may include neck and arm pain, weakness, leg dysfunction, and/or paralysis.
| Spinal Nerve |
Body Area: Function and Feeling |
| C1 and C2 |
Head |
| C3 and C4 |
Diaphragm; a muscle below your rib cage important to breathing |
| C5 |
Deltoids; shoulder muscles |
| C6 |
Biceps; upper arm flexionWrists; flexion and extension |
| C7 |
Triceps; muscles that straighten your elbow |
| C8 |
Hands |
Accurate diagnosis
Consult an expert about your neck pain, pre-existing spinal stenosis or changing spinal disorder. An accurate diagnosis is essential to an effective and successful treatment plan.
- Do any family members have spinal stenosis?
- Have you had previous back surgery?
- When did your symptoms start and how have they changed?
Your medical history and physical and neurological examinations are very important. You and your doctor discuss your symptoms, their severity, and treatments tried. The doctor tests your reflexes and evaluates you for muscle weakness, loss of feeling, and signs of neurological injury.
Diagnostic testing may include x-rays, CT or MRI scans, or myelography to enhance the surgeon's examination of your nerve roots and spinal cord.
Treatment options
Patients with spinal stenosis find non-surgical treatment helps to relieve pain and symptoms. Your doctor may combine two or more therapies to maximize your treatment success.
Non-surgical treatments
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Pain medication (a narcotic, painkiller)
- Muscle relaxing medication
- Spinal injection
- Short-term bracing relieves some of the weight of the head off the neck
- Physical therapy
- Traction
- Acupuncture
When your surgeon may discuss surgical treatment
- Spinal instability
- Neurologic dysfunction
- Pain and symptoms are unrelenting
- Non-operative treatment fails and pain persists
Surgical treatment
The goal of surgery is to decompress—take pressure off—the nerve roots and/or spinal cord. Decompression is a surgical procedure that involves trimming or removing whatever is causing compression. Many procedures can be performed using minimally invasive surgical techniques and instruments. Your surgeon will discuss the most appropriate procedure for you and help you understand the possible risks and benefits.
Decompressive laminectomy removes (ectomy) the lamina to create more space around spinal nerves and/or the spinal cord. The procedure is called a decompressive laminotomy when part (otomy) of the lamina is removed.
Laminoplasty expands the size of the spinal canal by lifting one side of the lamina. This procedure retains spinal stability and reduces the need for fusion.
Discectomy removes a part or the entire intervertebral disc.
Foraminotomy enlarges the size of the neuroforamen to decompress nerve roots.
Instrumentation and fusion stabilize the spine and may be combined with another procedure, such as discectomy. Instrumentation utilizes screws and plates to secure the neck. Bone graft is packed around the instrumentation to help the spine heal and fuse two or more vertebrae together.
Next steps
We hope this information about cervical spinal stenosis has answered your immediate questions. Remember, your doctor is your most valuable source to answer your questions about symptoms and your healthcare.
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