Understanding Cervical Stenosis

Article written by Al Rhyne, MD & Brian Claytor, MD

What is it?

Stenosis refers to narrowing of a structure in this case the spinal canal, or the bony tube in which the spinal cord and the nerve roots travel. The cervical spine is the upper portion of the spine, consisting of 7 vertebral bodies that make up what we know as the neck. Each individual vertebral body is separated by a gel-like disc that provides a cushion between the bones and allows motion to occur. Individual nerves roots branch off the spinal cord at each level and make up the nerves to the arms and hands. Also, there are ligaments that run along the length of the spinal column that help to provide stability.

How does it happen?

Stenosis of the cervical spine is most often due to degenerative changes in the spine that are the result of "wear and tear" usage and typically progresses as people age. Sometimes, a portion of a disc may herniate (rupture) and put pressure on the nerves. As the degenerative changes progress, the discs may collapse and decrease in height, leaving less room for the nerves. In addition, the ligaments of the spine may thicken and bone spurs (osteophytes) may form on the vertebral bodies. These changes all contribute to the narrowing of the spinal column and may lead to increased pressure on the spinal cord. There are also some other less common causes of stenosis in the cervical spine. Rarely, one may be born with abnormalities in the spine that create a congenital stenosis. Trauma, or injury to the neck, is another potential reason. Other causes such as tumor, infection, or calcification of the ligaments are rare.

How is it diagnosed?

Cervical stenosis is usually suspected based on the patients history and physical examination. Your doctor may order X-rays of the neck. X-rays may show bone spurs or narrowing of the space between vertebral bodies, caused by collapse of the discs. A more specialized type of imaging, magnetic resonance imaging (MRI) may also be obtained. The MRI will show the condition of the intervertebral discs, the ligaments, and the spinal cord and nerves. The MRI is the most common way to diagnose the presence of nerve compression. Other types of imaging studies such as CT scans and myeolograms may also be used in certain cases to help make the diagnosis.

What are the symptoms?

Often, cervical stenosis is not symptomatic and is only a finding noted on X-ray or MRI. However, when it does become symptomatic, it most often causes pain or numbness in the arms and/or hands often referred to as radiculopathy. Neck pain often accompanies cervical stenosis as the joints in the spine become arthritic and stiff. Stenosis that affects the exiting nerve roots most often affects only one side of the body and the location of the pain and numbness is related to which nerve is being compressed. These symptoms are usually intermittent at first and may be related to certain positions of the neck or arms. Occasionally, pinched nerves in the upper part of the neck may cause headaches. As the stenosis worsens, it may cause compression of the spinal cord itself. This can cause a wide variety of symptoms, such as numbness and weakness in the arms and/or legs, loss of manual dexterity in the hands (such as difficulty buttoning shirts), loss of balance, or incontinence. If any of these symptoms are present, you should let your doctor know.

What can be done?

Most often, cervical stenosis can be treated with stretching and strengthening exercises, over the counter medications, and lifestyle modifications. Your doctor may add physical therapy to the treatment regimen. Sometimes, acute flare-ups may be treated with a brief course of oral steroids and/or pain medications. Injections using local anesthetic agents or steroids may be done in certain cases by specially trained physicians to help relieve pain. If the symptoms persist, or are severe, your doctor may recommend surgery. Smaller procedures might involve only removing the bone or a portion of the herniated disc that is causing the compression. Other procedure may involve fusions with metal instrumentation, such as plates, rods, and screws. Surgery on the neck may be performed from the front, back, or both. The appropriate treatment protocol, including which, if any, surgical procedures are warranted, is a decision that is made by patient and physician and is based on the individual circumstances of each case.