(See also Evaluation of Neck and Back Pain Evaluation of Neck and Back Pain Neck pain and back pain are among the most common reasons for physician visits. This discussion covers neck pain involving the posterior neck (not pain limited to the anterior neck) and low... read more .)
Cervical spine stenosis can be congenital or acquired. The most common causes are osteoarthritis Osteoarthritis (OA) Osteoarthritis is a chronic arthropathy characterized by disruption and potential loss of joint cartilage along with other joint changes, including bone hypertrophy (osteophyte formation). Symptoms... read more , degenerative disk disorders, spondylosis Cervical Spondylosis and Spondylotic Cervical Myelopathy Cervical spondylosis is osteoarthritis of the cervical spine causing stenosis of the canal and sometimes cervical myelopathy due to encroachment of bony osteoarthritic growths (osteophytes)... read more , and spondylolisthesis Spondylolisthesis Spondylolisthesis is slippage of a lumbar vertebra in relation to the vertebra below it. Anterior slippage (anterolisthesis) is more common than posterior slippage (retrolisthesis). Spondylolisthesis... read more with compression of the spinal cord. Other causes include Paget disease of bone Paget Disease of Bone Paget disease of bone is a chronic disorder of the adult skeleton in which bone turnover is accelerated in localized areas. Normal matrix is replaced with softened and enlarged bone. The disease... read more and ankylosing spondylitis Ankylosing Spondylitis Ankylosing spondylitis is the prototypical spondyloarthropathy and a systemic disorder characterized by inflammation of the axial skeleton, large peripheral joints, and digits; nocturnal back... read more .
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 Symptoms and Signs Various lesions can compress the spinal cord, causing segmental sensory, motor, reflex, and sphincter deficits. Diagnosis is by MRI. Treatment is directed at relieving compression. (See also... read more (myelopathy) with loss of balance and weakness and spasticity in the 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.
Diagnosis of Cervical Spinal Stenosis
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
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 Treatment references Cervical spinal stenosis is narrowing of the cervical spinal canal causing compression of the nerve roots before their exit from the foramina. It causes positional neck pain, symptoms of nerve... read more , 2 Treatment references Cervical spinal stenosis is narrowing of the cervical spinal canal causing compression of the nerve roots before their exit from the foramina. It causes positional neck pain, symptoms of nerve... read more ).
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