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Overview

Cervical stenosis is a condition that occurs when there is narrowing (i.e. stenosis) of the passages through which the spinal cord and nerves travel inside the cervical (neck) spine. Typically, this narrowing results from arthritic overgrowth of the bones, joints, and ligaments of the cervical spine.

Stenosis develops slowly and is progressive. It is therefore more common as we age. Symptoms can include neck pain, pain radiating to the arms and hands, numbness, and/or tingling. In severe cases, there can be hand weakness, loss of dexterity, and even difficulty with balance.

Treatment for cervical stenosis depends on the type and severity of symptoms. For most patients, with mild to moderate cervical stenosis, physical therapy that includes traction and skeletal stabilization is enough to reverse or reduce symptoms. Only severe cases need surgery.

Symptoms

Symptoms of cervical stenosis can be caused either by narrowing of the central spinal canal in the neck (central stenosis) or by a narrowing of the passages (foraminal stenosis) where nerve roots exit the spinal canal, travelling to the shoulders, arms, and hands.

Central cervical stenosis results in compression of the spinal cord, which is the conduit for signals between the brain and various body parts. As a result of compression, these signals do not get transmitted properly. Patients with central cervical stenosis usually present with symptoms of spinal cord irritation or dysfunction, including numbness, weakness, imbalance, and loss of coordination.

Foraminal cervical stenosis results in pinching of a spinal nerve as it exits the spinal column on its way to the shoulders, arms, and hands. Commonly, foraminal stenosis causes symptoms of pain shooting down the arm. Spasms of the neck and shoulder areas may also occur. Numbness, tingling, burning and/or cramping sensations may also be felt in the arm, hands, or fingers. More severe cases may cause muscle weakness or loss of muscle tone.

Causes

Most cases of cervical stenosis build up over time, as a result of arthritic changes in the bones, joints and ligaments that surround the spinal cord and spinal nerves. Eventually, these arthritic changes can cause a narrowing of either the spinal canal itself or around the passage (e.g. foramen) where the nerves leave the spine on their way to the shoulders, arms, and hands. Cervical stenosis is commonly seen in people ages 50 and older. Stenosis can be due to other reasons, such as tumors or fractures, which may cause symptoms to occur in younger age groups.

Diagnosis

Through a detailed history and exam, your doctor can distinguish whether your symptoms are caused by cervical stenosis, or by an unrelated problem such as vitamin deficiency, stroke, or ALS. The cause of symptoms can NEVER be diagnosed from an MRI alone. The exam typically includes:

  • Range of motion test: Assessing how far you can move your spine in each direction and which movements cause pain or electrical sensations.
  • Neurological assessment: A group of tests that evaluates your nervous system to localize where your symptoms are originating. This assessment includes testing:
    • Strength in the individual muscles of the arms and legs
    • Coordination and fine movements
    • Reflexes
    • Walking and balance
    • Sensation to light touch and pin prick
  • Palpation: Touching, pushing, and squeezing of muscles and other structures to determine alignment, spasms, and provoked sensations.

Depending on what your doctor finds on your exam he or she may make a diagnosis of cervical stenosis. If necessary, your doctor may order further testing to refine the diagnosis.

  • X-ray: An image of the bones in your spine. An x-ray can locate arthritic changes in the vertebrae, including the location and severity of bone spurs. Load bearing X-rays can also be used to assess abnormal bone alignment, which may contribute to your stenosis symptoms.
  • MRI (magnetic resonance imaging): An image of the soft tissues of the spine, which cannot be seen on X-ray. Most commonly an MRI will be ordered for the physician to locate the exact level of neural compression involved in cervical stenosis. MRI can also locate tumors, damaged discs, and loose ligaments in the spine causing pressure on the spinal cord.
  • Electromyography (EMG): An EMG measures the activity of the muscles at rest and during contraction, determining the communication of the nerve to the muscle. In an EMG test, needles are used in addition to electrodes. This study helps evaluate the extent of possible nerve damage involved in your cervical stenosis.

Treatment

Most patients improve with conservative treatments, such as structured physical therapy, using a combination of traction, core strengthening, skeletal stabilization, and postural training. These can be performed in combination with medications. With proper physical therapy, muscles around the cervical spine become stronger and help to stabilize the arthritic and inflamed joints that are the underlying cause of cervical stenosis. In addition, physical therapists will teach you how to properly use your neck during daily activities; thereby, reducing stress and inflammation of these joints.

  • Medication treatment:
    • Over-the-counter medications such as Advil or Tylenol may be used to treat your pain if symptoms are mild or moderate.
    • Anti-depressants have been used to treat chronic pain symptoms, including chronic pain caused by cervical stenosis.
    • Anti-seizure medications can be used to treat nerve pain caused by the pinching of nerves from cervical stenosis.
    • Opioids are used when pain symptoms are severe. Often, they are prescribed for short-term use while waiting for the beneficial effects of other therapies, or to allow a patient to tolerate exercise therapy.
  • Physical Therapy: Physical Therapy may be prescribed in conjunction with other treatments such as pain medication and/or epidural injections to help with your symptoms. Physical therapists can perform manual therapy and provide you with a program of stretching and exercises to help alleviate your symptoms. Physical therapists will also teach you how to strengthen muscles in your upper back, shoulders, and neck. As these muscles grow stronger, they will help stabilize the degenerated, arthritic joints and ligaments in your spine that are the underlying cause of cervical stenosis.
  • Epidural Steroid Injection: A physician performs an image guided injection to the nerve root thought to be the source of the patient’s symptoms. While corticosteroids do not fix cervical stenosis, they do help decrease the inflammation surrounding the neural tissue. The steroid acts like “a bucket of water thrown on the fire” decreasing the patient’s severe symptoms caused by inflammation.
  • Surgery: For patients with advanced stenosis, surgery may be necessary to prevent further spinal cord or nerve damage, and to maximize the chance of returning to normal function. Typically, the goal of surgery is to enlarge the narrowed passages where the spinal cord and nerves travel. If the joints are unstable, fusion may be required.
    • Laminectomy: A portion of the vertebrae known as the lamina is removed, along with overgrown joints, bone spurs, and thickened ligaments, to allow the spinal cord more room to travel.
    • Foraminotomy: A “roto rooter” procedure that cleans out the small tunnels that nerves use to exit the spinal column, giving these nerves more space.
    • Spinal Fusion: If the arthritic joints and ligaments are so diseased that they can no longer maintain the spinal column in proper alignment, stabilization surgery may be warranted in addition to the decompression provided by laminectomy or foraminotomy. This process of stabilization is known as spinal fusion surgery, and entails realigning the bones and fixing them in proper position using titanium screws and rods.

Summary

Cervical stenosis is a common condition affecting the aging spine, and tends to be progressive. It most commonly results from arthritic, overgrown joints and ligaments in the spine crowding into the spaces occupied by the spinal cord and nerves.

Fortunately, most patients with mild to moderate symptoms can be effectively treated with conservative care, and can learn how to keep themselves symptom free. Surgery, reserved only for severe cases, is extremely effective, and can help return patients to active lifestyles.

Call for a consultation today with one of our qualified medical practitioners for an evaluation of your symptoms and an individualized treatment plan tailored to meet your goals and needs.

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