Cervical spinal stenosis is a condition in which the spinal canal in the neck is too small for the spinal cord and exiting spinal nerves. The narrow canal results in pinching of these important structures, which can eventually lead to a variety of symptoms. Spinal stenosis most often develops as a result of a combination of disc degeneration, bone spurs, thickened ligaments, and lax joints in the spine. However, some people are genetically predisposed to develop a small spinal canal diameter, and others can develop stenosis as a result of rhuematoid arthritis, osteoarthrits, nicotine use, or due to a fall or other injury.

 

Cervical spinal stenosis develops over a period of months or years. Though the patient may not be aware of its development, spinal stenosis may become rapidly apparent once the dimensions of the spinal canal become critically small.

 

Many patients with cervical stenosis experience neck pain or headaches, although some patients have symptoms in the shoulder, arm or hand, but do not have neck pain. Symptoms caused by pinched spinal nerves in the neck may also cause pain, numbness, or weakness anywhere in the upper extremity, so cervical stenosis should be considered as a possibility in patients who appear to have conditions such as carpal tunnel syndrome or rotator cuff tears, though these conditions may exist together. 

 

If the stenosis has reached a point where it begins to press not only on the nerves but also on the spinal cord itself, patients can experience myelopathy. The symptoms of myelopathy may include changes in handwriting or loss of fine motor skills in the hands, such as difficulty buttoning shirts or using zippers. Cervical stenosis also may cause difficulty with balance and walking which can be perceived as a worsening clumsiness by the patient and their family.

Patients with symptoms of early cervical stenosis may be successfully treated with physical therapy (including cervical traction), anti-inflammatory medications, steroid injections, chiropractic care, massage, or short-term use of a soft collar.

Patients with persistent disabling symptoms despite a trial of conservative treatments may benefit from a cervical operation. Surgical options include a discectomy or corpectomy (removal of the front of the vertebra) and fusion from the front of the neck, or a laminectomy (removing the bony covering over the spinal cord) and fusion from the back of the neck.

 

Patients experiencing symptoms of myelopathy may benefit from early surgical intervention. Unfortunately, the symptoms of myelopathy may be irreversible despite surgical decompression of the spinal cord, so surgery for myelopathy is considered successful if it only preserves the patient’s current functional status and prevents further progression of their symptoms.