Cervical spinal stenosis is narrowing of the spinal canal in the neck. As the canal becomes smaller, it can place pressure on the spinal cord and, in some cases, the nerve roots traveling into the arms.
Cervical spinal stenosis is most commonly caused by age-related degeneration of the discs, joints, and ligaments of the cervical spine. Many people have some narrowing on an MRI without significant symptoms. When stenosis becomes severe enough to interfere with spinal cord function, it can cause cervical myelopathy.
Cervical myelopathy is particularly important because it may cause problems with the hands, arms, legs, walking, and balance. Progressive spinal cord dysfunction often requires surgical treatment.
What Is Cervical Spinal Stenosis?
The cervical spine consists of seven vertebrae, labeled C1 through C7.
The spinal cord travels through a central opening within these vertebrae called the spinal canal.
Over time, degenerative changes can reduce the amount of space available for the spinal cord.
Narrowing may result from a combination of:
- Disc bulging
- Disc herniation
- Bone spurs
- Facet joint arthritis
- Thickening or buckling of the ligamentum flavum
- Ossification of the posterior longitudinal ligament
- Spondylolisthesis
- Congenitally narrow spinal canal
When these changes become significant, the spinal cord may be compressed.
What Causes Cervical Spinal Stenosis?
The most common cause is gradual degeneration of the cervical spine.
As the discs age, they may lose height and begin to bulge. The body may respond by forming bone spurs around the edges of the vertebrae.
At the same time, the facet joints can enlarge and ligaments may thicken.
Together, these changes can progressively narrow the spinal canal.
Other causes include:
- Congenital spinal stenosis
- Ossification of the posterior longitudinal ligament (OPLL)
- Previous cervical spine surgery
- Spinal deformity
- Trauma
- Tumor
- Infection
- Inflammatory conditions
Some patients have several contributing factors.
Cervical Spinal Stenosis Versus Cervical Myelopathy
These terms describe related but different problems.
Cervical spinal stenosis describes the physical narrowing of the spinal canal.
Cervical myelopathy means that the spinal cord is no longer functioning normally because of compression or another abnormality.
A patient can therefore have significant stenosis without myelopathy.
Once symptoms or examination findings indicate spinal cord dysfunction, the condition is often called degenerative cervical myelopathy or cervical spondylotic myelopathy.
This distinction is important because the presence of myelopathy can significantly affect treatment recommendations.
Symptoms of Cervical Spinal Stenosis
Mild cervical stenosis may cause no symptoms.
When the spinal cord or nerves become compressed, symptoms may include:
- Neck pain
- Shoulder pain
- Arm pain
- Numbness or tingling in the hands
- Hand weakness
- Loss of hand coordination
- Difficulty walking
- Poor balance
- Leg stiffness or heaviness
- Weakness in the arms or legs
Some patients have little neck pain despite significant spinal cord compression.
Hand Symptoms
One of the characteristic features of cervical myelopathy is deterioration in fine motor control of the hands.
Patients may notice difficulty:
- Buttoning a shirt
- Writing
- Using utensils
- Handling coins
- Typing
- Using a phone
- Manipulating small objects
Objects may be dropped more frequently.
These symptoms can develop gradually and may initially be mistaken for arthritis, carpal tunnel syndrome, or normal aging.
Walking and Balance Problems
The spinal cord carries nerve signals between the brain and the legs.
When it becomes compressed in the neck, patients may develop:
- Unsteady walking
- Poor balance
- Leg stiffness
- A heavy feeling in the legs
- Difficulty climbing stairs
- Frequent stumbling
- Frequent falls
Some patients describe feeling as though their legs do not respond normally even though the problem originates in the neck.
Progressive walking difficulty is an important symptom of cervical myelopathy.
Cervical Stenosis and Radiculopathy
Cervical stenosis may occur together with cervical radiculopathy.
Radiculopathy occurs when an individual nerve root is compressed.
This may cause:
- Pain traveling into the shoulder or arm
- Numbness or tingling
- Weakness in specific muscles
- Changes in reflexes
A patient can have:
- Spinal cord compression alone
- Nerve root compression alone
- Both at the same time
Treatment depends on which structures are being compressed and which symptoms they are producing.
How Is Cervical Spinal Stenosis Diagnosed?
Diagnosis begins with a detailed history and neurologic examination.
The examination may evaluate:
- Arm and leg strength
- Sensation
- Reflexes
- Hand coordination
- Walking
- Balance
- Signs of spinal cord dysfunction
Imaging is then used to determine the location and severity of compression.
MRI
MRI is generally the most important imaging study for cervical spinal stenosis.
MRI can demonstrate:
- Spinal canal narrowing
- Spinal cord compression
- Disc herniations
- Bone spurs
- Ligament thickening
- Nerve root compression
- OPLL
MRI may also show abnormal signal within the spinal cord.
Changes in spinal cord signal can indicate that chronic compression has begun to affect the cord itself.
X-Rays
Cervical X-rays can provide information about:
- Spinal alignment
- Disc degeneration
- Bone spurs
- Spondylolisthesis
- Cervical lordosis
- Kyphosis
Flexion-extension X-rays may sometimes be used to determine whether abnormal movement or instability is present.
CT Scan
CT provides excellent detail of the bones of the cervical spine.
It can be particularly helpful for evaluating:
- Bone spurs
- OPLL
- Facet arthritis
- Previous fusion
- Surgical anatomy
CT may also be used when MRI cannot be performed.
Nonsurgical Treatment
Patients with cervical stenosis but without significant spinal cord dysfunction may sometimes be treated without surgery.
Treatment may include:
- Activity modification
- Physical therapy
- Anti-inflammatory medications
- Pain medications
- Treatment of associated radiculopathy
- Clinical observation
Nonsurgical treatment can help manage pain but does not physically remove significant spinal cord compression.
Patients being observed should be monitored for the development of myelopathy.
What About Cervical Epidural Steroid Injections?
Epidural steroid injections may sometimes be used for cervical radiculopathy, particularly when an inflamed nerve root is causing arm pain.
They do not treat spinal cord compression or cervical myelopathy.
Injections should therefore not be viewed as a treatment for significant cervical spinal cord dysfunction.
When Is Surgery Considered?
Surgery is more likely to be recommended when cervical stenosis causes:
- Progressive hand weakness
- Loss of hand coordination
- Difficulty walking
- Progressive balance problems
- Leg stiffness or weakness
- Significant cervical myelopathy
- Progressive neurologic deterioration
Surgery may also be considered for severe nerve root symptoms that do not improve with appropriate nonsurgical treatment.
The decision is based on symptoms, neurologic examination, imaging, spinal alignment, and progression over time.
What Is the Goal of Surgery?
For patients with cervical myelopathy, the primary goal of surgery is to relieve pressure on the spinal cord and prevent further neurologic deterioration.
Many patients also experience improvement in:
- Walking
- Balance
- Hand function
- Strength
- Numbness
However, recovery varies.
Spinal cord symptoms that have been severe or present for a long time may not completely resolve even after successful decompression.
This is one reason progressive myelopathy should not be ignored.
Anterior Cervical Discectomy and Fusion
Anterior cervical discectomy and fusion (ACDF) is a common treatment for cervical stenosis.
The spine is approached through the front of the neck.
The surgeon removes the damaged disc and bone spurs causing compression.
A spacer or cage is then placed between the vertebrae, and the level is fused.
ACDF can be particularly useful when compression is located primarily in front of the spinal cord.
Cervical Corpectomy
A cervical corpectomy involves removing part or most of a vertebral body along with adjacent discs.
It may be considered when spinal cord compression extends behind a vertebral body and cannot be adequately addressed through a standard discectomy.
The removed vertebral body is reconstructed with a cage or structural graft, and the spine is stabilized.
Cervical Laminectomy and Fusion
A cervical laminectomy removes the back portion of the spinal canal to create additional space for the spinal cord.
When combined with fusion, screws and rods stabilize the cervical spine.
This approach may be useful for:
- Multilevel spinal stenosis
- Compression across several levels
- Certain alignment patterns
- Patients who are not ideal candidates for a multilevel anterior procedure
Cervical Laminoplasty
Cervical laminoplasty enlarges the spinal canal while preserving motion between the vertebrae.
Instead of removing the lamina completely, the surgeon creates a controlled opening in the back of the spinal canal.
Laminoplasty may be appropriate for selected patients with:
- Multilevel cervical stenosis
- Preserved cervical alignment
- No significant instability
It is not appropriate for every patient.
Anterior Versus Posterior Surgery
There is no single operation that is best for every case of cervical stenosis.
The surgical approach depends on:
- Number of levels involved
- Location of spinal cord compression
- Cervical alignment
- Presence of kyphosis
- Spinal instability
- OPLL
- Previous surgery
- Associated nerve root compression
Some patients are best treated from the front of the neck, others from the back, and selected complex cases may require both approaches.
Ossification of the Posterior Longitudinal Ligament
OPLL occurs when the posterior longitudinal ligament gradually becomes thickened and replaced by bone.
Because this ligament lies directly in front of the spinal cord, OPLL can cause substantial cervical stenosis.
Treatment depends on:
- Severity of compression
- Number of involved levels
- Cervical alignment
- Presence of myelopathy
Surgical planning can differ from that used for routine degenerative cervical stenosis.
Congenital Cervical Stenosis
Some people are born with a spinal canal that is smaller than average.
This is called congenital cervical stenosis.
A person with a naturally narrow canal has less space available for the spinal cord. As a result, relatively modest degenerative changes later in life may produce significant compression.
Congenital stenosis does not necessarily require treatment unless it produces symptoms or spinal cord dysfunction.
Cervical Stenosis and Spinal Cord Injury
Severe cervical stenosis can leave the spinal cord with relatively little space.
In this situation, trauma or sudden movement of the neck may sometimes cause spinal cord injury even without a major fracture.
This is one reason severe stenosis accompanied by myelopathy deserves careful evaluation.
Can Cervical Myelopathy Get Worse?
Yes.
The natural history varies from patient to patient, but cervical myelopathy can progress over time.
Deterioration may be gradual or occur in periods of stability followed by worsening.
Progressive symptoms may include:
- Increasing hand clumsiness
- Worsening weakness
- Greater difficulty walking
- Increasing falls
- Loss of independence
Once significant spinal cord injury has occurred, some deficits may become permanent.
Recovery After Surgery
Recovery depends on:
- Severity of spinal cord compression
- Duration of symptoms
- Degree of neurologic impairment before surgery
- Number of levels treated
- Type of surgery
- Age and overall health
Patients may notice improvement over weeks or months.
Walking and hand function can continue to improve for an extended period after decompression.
The primary objective, however, remains preventing continued damage to the spinal cord.
When Should Cervical Spinal Stenosis Be Evaluated Promptly?
Prompt evaluation is appropriate for:
- New or progressive arm or leg weakness
- Increasing hand clumsiness
- New difficulty walking
- Progressive balance problems
- Frequent unexplained falls
- Rapid neurologic deterioration
- New bowel or bladder dysfunction associated with other neurologic symptoms
These findings may indicate significant cervical spinal cord dysfunction.
Outlook
Cervical spinal stenosis is common, particularly as people age.
The presence of narrowing on an MRI does not automatically mean surgery is necessary.
Treatment should be based on the combination of:
- Symptoms
- Neurologic examination
- Severity of spinal cord compression
- Presence or absence of myelopathy
- Cervical alignment
- Progression over time
- Patient goals
Patients with stenosis but no significant neurologic dysfunction may sometimes be monitored or treated nonsurgically.
When cervical stenosis causes progressive myelopathy, weakness, loss of hand function, or difficulty walking, surgical decompression may be recommended to protect the spinal cord and preserve neurologic function.
Related Topics
- Cervical Myelopathy
- Cervical Radiculopathy
- Cervical Foraminal Stenosis
- Cervical Disc Herniation
- Cervical Spondylosis
- OPLL
- Anterior Cervical Discectomy and Fusion (ACDF)
- Cervical Corpectomy
- Cervical Laminectomy and Fusion
- Cervical Laminoplasty