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What is cervical spinal stenosis?
Cervical spinal stenosis is the narrowing of the spinal canal in the neck. The spinal canal is the open area in the bones (vertebrae) that make up the spinal column. The spinal cord is a collection of nerves that runs through the spinal canal from the base of the brain to the lower back. These nerves allow us to feel, to move, and to control the bowel and bladder and other body functions. In cervical spinal stenosis, the spinal canal narrows and can squeeze and compress the nerve roots where they leave the spinal cord, or it may compress or damage the spinal cord itself. The seven vertebrae between the head and the chest make up the cervical spine. Squeezing the nerves and cord in the cervical spine can change how the spinal cord functions and cause pain, stiffness, numbness, or weakness in the neck, arms, and legs. It can also affect your control of your bowels and bladder.
What causes cervical spinal stenosis?
Cervical spinal stenosis is usually caused by age-related changes in the shape and size of the spinal canal and so is most common in people older than age 50. The aging process can cause a "bulging of the discs"—the spongy discs between the bones of the spine bulge out farther than normal—or a thickening of tissues that connect bones (ligaments). Aging can also lead to destruction of tissues that cover bones (cartilage) and excessive growth of the bones in joints. These conditions can narrow the spinal canal (spinal stenosis).
In rare cases, the spinal canal is narrowed from birth because of the way the bones are formed.
What are the symptoms?
Many people older than age 50 have some narrowing of the spinal canal but do not have symptoms. Cervical spinal stenosis does not cause symptoms unless the spinal cord or nerves becomes squeezed. Symptoms usually develop gradually over a long period of time and may include:
How is cervical spinal stenosis diagnosed?
A diagnosis of cervical spinal stenosis usually is based on your history of symptoms and a physical exam. Your doctor will ask you if neck movements cause pain, numbness, or weakness. If cervical spinal stenosis is suspected, your doctor will recommend imaging tests of your neck and back to confirm the diagnosis and to see what is causing the narrowing of the spinal canal. Imaging tests that may be used include X-rays, magnetic resonance imaging (MRI), and computed tomography (CT) scans. Your doctor will use the results of tests, including imaging and blood tests, to eliminate other diseases—such as multiple sclerosis (MS) and vitamin B12 deficiency—as the cause of your symptoms.
How is it treated?
In mild cases of spinal stenosis, symptoms can usually be controlled with medicine to relieve pain, exercise to maintain strength and flexibility, and physical therapy. If your symptoms are severe, you have progressive weakness of your muscles, or the pictures of your spine show that your spinal cord or nerves are being tightly squeezed, your doctor is likely to recommend decompressive surgery to relieve the pressure. This surgery may be done from the front or the back of the neck. It involves removing some of the disc, bone, and/or tissue that may be pressing on the nerve roots. Vertebrae are often joined together surgically (fused) to provide stability to the spine.
Cervical spinal stenosis can potentially cause serious problems with the nervous system, including problems with bowel or bladder control (incontinence) and permanent loss of strength and feeling in the arms, hands, and legs. Your doctor will not wait for you to have severe symptoms of pain, weakness, and numbness before considering treatment to relieve pressure on your spinal cord and nerves.
The North American Spine Society (NASS) promotes education, research, and advocacy for spine care. This group's patient education website (www.KnowYourBack.org) has information on the cause, treatment, and prevention of neck and back problems. It has references and brochures to help patients make health decisions. NASS members are spine care professionals such as orthopedic surgeons, neurosurgeons, neurologists, physiatrists, physical therapists, and researchers.
RadiologyInfo is a joint project of the American College of Radiology and the Radiological Society of North America. The website is designed to answer consumer questions about radiology procedures and therapies. RadiologyInfo has information on X-ray, CT scan, MRI, ultrasound, and other procedures. The information includes how they are used for diagnosis and treatment, how to prepare for the procedures, and what a patient may experience.
The American Academy of Orthopaedic Surgeons (AAOS)
provides information and education to raise the public's awareness of
musculoskeletal conditions, with an emphasis on preventive measures. The AAOS
website contains information on orthopedic conditions and treatments, injury
prevention, and wellness and exercise.
The American College of Rheumatology (ACR) and the
Association of Rheumatology Health Professionals (ARHP, a division of ACR) are
professional organizations of rheumatologists and associated health
professionals who are dedicated to healing, preventing disability from, and
curing the many types of arthritis and related disabling and sometimes fatal
disorders of the joints, muscles, and bones. Members of the ACR are physicians;
members of the ARHP include research scientists, nurses, physical and
occupational therapists, psychologists, and social workers. Both the ACR and
the ARHP provide professional education for their members.
website offers patient information fact sheets about rheumatic diseases, about
medicines used to treat rheumatic diseases, and about care
The Arthritis Foundation provides grants to help find a
cure, prevention methods, and better treatment options for arthritis. It also
provides a large number of community-based services nationwide to make living
with arthritis easier, including self-help courses; water- and land-based
exercise classes; support groups; home study groups; instructional videotapes;
public forums; free educational brochures and booklets; the national, bimonthly
consumer magazine Arthritis Today; and continuing
education courses and publications for health professionals.
The National Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS) is a governmental institute that serves the public
and health professionals by providing information, locating other information
sources, and participating in a national federal database of health
information. NIAMS supports research into the causes, treatment, and prevention
of arthritis and musculoskeletal and skin diseases and supports the training of
scientists to carry out this research.
The NIAMS website provides
health information referrals to the NIAMS Clearinghouse, which has information
packages about diseases.
Other Works Consulted
Hu SS, et al. (2006). Cervical spondylosis section of Disorders, diseases, and injuries of the spine. In HB Skinner, ed., Current Diagnosis and Treatment in Orthopedics, 4th ed., pp. 238–242. New York: McGraw-Hill.
Meleger AL (2008). Cervical stenosis. In WR Frontera et al., eds., Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation, 2nd ed., pp. 27–31. Philadelphia: Saunders Elsevier.
February 13, 2012
William H. Blahd, Jr., MD, FACEP - Emergency Medicine & Robert B. Keller, MD - Orthopedics
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