The cervical spinal cord carries signals between the brain and the rest of the body. Cervical nerve roots branch from the spinal cord and travel into the shoulders, arms, and hands. These neurological structures are surrounded by protective membranes called the meninges, including the dura mater.
Please review the Cervical spine anatomy section for more information.
Disorders affecting the cervical spinal cord, nerve roots, or dura may result from compression, inflammation, injury, abnormal fluid collections, cysts, tumors, or other neurological conditions.
Disorders affecting a single nerve root usually cause symptoms in one arm or hand. Spinal cord disorders may affect both arms, the legs, balance, and other functions below the level of the abnormality.
Dural disorders may cause pain, neurological symptoms, or headaches related to changes in cerebrospinal fluid pressure.
Major Diagnosis Types
Below are the major types we see in our clinic. Click on available links to learn about our approach to the problems.
Cervical Spinal Cord Injury
A cervical spinal cord injury occurs when trauma or another sudden event damages the spinal cord in the neck.
Possible causes include:
- Motor vehicle accidents
- Falls
- Sports injuries
- Diving injuries
- Fractures or dislocations
- Severe disc herniation
- Epidural hematoma
- Spinal cord compression in a patient with cervical stenosis
The effects depend on the level and severity of the injury.
Possible symptoms include:
- Arm and leg weakness
- Paralysis
- Loss of sensation
- Difficulty breathing
- Loss of bowel or bladder control
- Abnormal reflexes
- Low blood pressure or heart-rate abnormalities
A complete spinal cord injury causes loss of function below the injury. An incomplete injury preserves some movement, sensation, or neurological function.
Suspected cervical spinal cord injury is a medical emergency.
Minor Diagnosis Types
These terms are often encountered, but are either less often treated or described within one of the above diagnoses.
Cervical Arachnoid Cyst
A cervical arachnoid cyst is a fluid-filled sac involving the arachnoid membrane surrounding the spinal cord.
These cysts may be located inside or outside the dura. Some are present from birth, while others develop following trauma, infection, inflammation, bleeding, or previous surgery.
Many arachnoid cysts cause no symptoms.
A larger cyst may compress the spinal cord or nerve roots and produce:
- Neck or back pain
- Arm or leg weakness
- Numbness
- Balance difficulty
- Trouble walking
- Bowel or bladder dysfunction
The importance of an arachnoid cyst depends on its size, location, and effect on neurological structures.
Cervical Meningeal and Perineural Cysts
Meningeal cysts are cerebrospinal fluid-filled outpouchings involving the membranes around the spinal cord or nerve roots.
Perineural cysts, sometimes called Tarlov cysts, form around a nerve root. They are much more common in the sacral spine but may rarely occur in the cervical region.
Most cervical meningeal or perineural cysts are incidental and cause no symptoms.
Rarely, a cyst may contribute to:
- Neck pain
- Arm pain
- Numbness
- Weakness
- Nerve root compression
A cyst found on imaging should not automatically be assumed to be the source of symptoms.
Cervical Myelomalacia
Myelomalacia refers to structural damage or softening within the spinal cord.
In the cervical spine, it most often develops from long-standing spinal cord compression. It may also follow trauma, impaired blood supply, inflammation, or another spinal cord injury.
Myelomalacia may be associated with:
- Hand weakness or clumsiness
- Balance difficulty
- Leg stiffness
- Abnormal reflexes
- Progressive walking impairment
- Loss of bowel or bladder control in advanced cases
Myelomalacia represents a change within the spinal cord rather than simply narrowing around it. The severity and clinical importance depend on the patient’s symptoms, neurological findings, and underlying cause.
Cervical Nerve Root Injury
A cervical nerve root may be injured by compression, stretching, direct trauma, inflammation, or surgical injury.
Potential causes include:
- Severe disc herniation
- Foraminal stenosis
- Fracture or dislocation
- Traction injury
- Tumor
- Infection
- Previous cervical surgery
- Brachial plexus injury
Symptoms may include:
- Arm pain
- Numbness
- Weakness
- Reduced reflexes
- Muscle wasting
Recovery depends on the severity and duration of the injury. Temporary irritation may resolve, while severe structural injury may produce lasting weakness or sensory loss.
Cervical Nerve Root Avulsion
A nerve root avulsion occurs when a cervical nerve root is torn away from the spinal cord.
This is a severe injury that usually results from high-energy trauma involving the shoulder and neck. It commonly occurs as part of a brachial plexus injury.
Possible symptoms include:
- Severe arm weakness or paralysis
- Loss of sensation
- Muscle wasting
- Burning or electric nerve pain
- Loss of normal reflexes
Unlike a more distant peripheral nerve injury, a nerve root avulsion occurs close to or within the spinal cord and generally cannot be repaired with a simple direct nerve repair.
Cervical Pseudomeningocele
A pseudomeningocele is an abnormal collection of cerebrospinal fluid outside the normal dural covering.
It usually develops when a tear or opening in the dura allows cerebrospinal fluid to escape into nearby tissues.
Possible causes include:
- Previous cervical spine surgery
- Trauma
- Nerve root avulsion
- Congenital dural abnormalities
- Spontaneous dural tears
A pseudomeningocele may cause:
- Neck swelling
- Neck or arm pain
- Headaches
- Nausea
- Neurological symptoms
- Drainage of clear fluid through a surgical incision in rare cases
Some pseudomeningoceles resolve without intervention, while persistent or symptomatic collections require further evaluation.
Cervical Spinal Cord Edema
Spinal cord edema is swelling within the spinal cord.
It may develop after:
- Trauma
- Acute compression
- Inflammation
- Infection
- Tumor
- Impaired blood flow
- Radiation injury
Symptoms may begin suddenly or progress over time.
Spinal cord edema can cause weakness, numbness, coordination problems, or difficulty walking. Because swelling may indicate an active spinal cord injury, the underlying cause should be identified promptly.
Cervical Syringomyelia
Cervical syringomyelia is the formation of a fluid-filled cavity, called a syrinx, within the cervical spinal cord.
A syrinx may gradually enlarge and injure spinal cord tissue.
Possible causes include:
- Chiari malformation
- Previous spinal cord injury
- Spinal cord tumor
- Arachnoid scarring
- Infection
- Abnormal cerebrospinal fluid flow
- Congenital spinal abnormalities
Symptoms may include:
- Neck or shoulder pain
- Weakness of the hands or arms
- Muscle wasting
- Loss of sensitivity to pain or temperature
- Numbness
- Stiffness
- Abnormal reflexes
- Balance difficulty
Some syrinxes remain small and stable, while others enlarge and cause progressive neurological dysfunction.
Intradural and Extradural Disorders
Cervical disorders may also be described according to their location relative to the dura.
Extradural disorders occur outside the dura. Common examples include:
- Disc herniations
- Bone spurs
- Epidural tumors
- Epidural abscesses
- Epidural hematomas
Intradural extramedullary disorders occur inside the dura but outside the spinal cord. Examples include:
- Meningiomas
- Schwannomas
- Arachnoid cysts
Intramedullary disorders occur within the spinal cord itself. Examples include:
- Syringomyelia
- Ependymoma
- Astrocytoma
- Inflammatory spinal cord lesions
The location of a disorder influences its symptoms and its effect on the spinal cord or nerve roots.