Symptoms

Cervical stenosis refers to the narrowing of the spinal canal in the neck (cervical spine) through which the spinal cord and nerve roots pass. This narrowing can lead to compression of the spinal cord and nerves, resulting in a range of symptoms. The severity and specific symptoms of cervical stenosis can vary depending on the degree of narrowing and the areas affected. Here are some common symptoms associated with cervical stenosis:

1. **Neck Pain:** Pain in the neck is a common symptom of cervical stenosis. It can vary in intensity and may radiate into the shoulders, arms, or even the hands.

2. **Arm and/or Leg Pain:** Cervical stenosis can cause pain that radiates from the neck down into the arms, and sometimes even into the legs. This pain can be sharp, burning, or tingling in nature. It often follows the path of the affected nerves and is known as "radiculopathy." You can also develop shooting pains into the arm or legs associated with neck movements.

3. **Numbness and Tingling:** People with cervical stenosis might experience numbness, tingling, or a sensation of pins and needles in the arms, hands, and fingers. This occurs due to the compression of the spinal cord and nerves that transmit sensory signals. These symptoms can be felt on one-side (unilateral) or both sides (bilateral).

4. **Loss of Fine Motor Skills:** Compression of the spinal cord can affect fine motor skills in the hands and fingers. Activities that require precision and coordination, such as buttoning a shirt or writing, might become more challenging. Sometime only one hand is affected but spinal cord compression can affect both hands.

4. **Muscle Weakness:** As the nerves are responsible for controlling muscles, cervical stenosis can lead to muscle weakness in the arms and sometimes the legs due to nerve compression. Weakness can affect grip strength, fine motor skills, and overall muscle function. Tasks such as opening doors knobs or pushing and pulling can be more difficult. Weakness can be one-sided (unilateral) or affect both sides (bilateral).

5. **Balance and Coordination Issues:** Severe cervical stenosis that compresses the spinal cord can lead to problems with balance and coordination. This might manifest as difficulty walking, stumbling, or a feeling of unsteadiness. This occurs late in the disease process but is generally an indication of progression.

6. **Bladder or Bowel Dysfunction:** In advanced cases of cervical stenosis where the spinal cord is severely compressed, patients might experience difficulties with bladder and bowel control due to disruption of the nerves that regulate these functions.

7. **Changes in Reflexes:** Reflexes can be affected by cervical stenosis. Reflexes may become exaggerated or diminished, indicating nerve compression or damage. But more often your reflexes will be especially brisk or hyperreflexic. This is an indication that your spinal cord may not be functioning properly.

It's important to note that cervical stenosis can develop gradually over time, and symptoms might worsen gradually as well. Some individuals with cervical stenosis might experience periods of exacerbation followed by periods of relative relief. If you experience any of the symptoms mentioned above, especially if they are persistent or worsening, it's essential to seek medical attention. A healthcare provider can conduct a thorough evaluation, including medical history, physical examination, and diagnostic tests such as MRI or CT scans, to accurately diagnose cervical stenosis and recommend appropriate treatment options.

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Diagnosis

Cervical stenosis refers to the narrowing of the spinal canal in the cervical (neck) region. This narrowing can lead to compression of the spinal cord and nerve roots, causing various neurological symptoms. The diagnosis of cervical stenosis typically involves a combination of clinical evaluation, medical history review, and various imaging tests. Here's an overview of the diagnostic process:

1. **Medical History and Physical Examination:**

A healthcare professional, often a neurologist, orthopedic surgeon, or spine specialist, will start by taking a detailed medical history. This includes asking about your symptoms, their onset, duration, and any exacerbating or relieving factors. They will also inquire about any past injuries, surgeries, or medical conditions related to the spine.

A thorough physical examination is conducted to assess your neurological function, including strength, sensation, reflexes, and coordination. The doctor will also examine your neck for signs of tenderness, muscle weakness, and any abnormal spinal curvatures.

2. **Imaging Studies:**

Imaging tests play a crucial role in confirming the diagnosis of cervical stenosis and assessing its severity. The most commonly used imaging modalities include:

**X-rays:** X-rays provide a basic view of the spinal anatomy and can show changes in the alignment of the vertebrae, presence of bone spurs, and signs of degeneration.

**MRI (Magnetic Resonance Imaging):** An MRI provides detailed cross-sectional images of the spine, allowing for visualization of the spinal cord, nerve roots, intervertebral discs, and surrounding soft tissues. MRI is particularly useful for detecting compression of neural structures and identifying the specific levels of stenosis.

**CT (Computed Tomography) Scan:** CT scans can offer detailed images of the bones and can be useful in assessing bony changes, such as bone spurs or fractures. CT myelography involves injecting a contrast dye into the spinal canal before the CT scan to enhance the visualization of nerve compression. This can be used instead of an MRI or if an MRI cannot be done.

3. **Electrodiagnostic Tests:**

In some cases, nerve function tests like electromyography (EMG) and nerve conduction studies (NCS) may be conducted. These tests evaluate the electrical activity of muscles and nerves, helping to identify the location and severity of nerve compression or damage.

4. **Clinical Assessment:**

Based on the information gathered from the medical history, physical examination, and imaging studies, the healthcare provider will assess the severity of cervical stenosis. They will determine whether the stenosis is causing neurological symptoms, such as pain, numbness, weakness, or problems with coordination.

It's important to consult with a qualified healthcare professional if you suspect you have cervical stenosis or are experiencing symptoms related to it. They can guide you through the appropriate diagnostic process and help determine the best course of action for your specific condition.

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Non-operativeTreatment

Non-operative treatment for cervical stenosis typically involves a combination of conservative approaches aimed at managing symptoms and improving functional outcomes. This may include physical therapy to strengthen neck muscles, improve posture, and enhance flexibility, as well as activity modification and ergonomic adjustments to reduce strain on the cervical spine. Pain management through over-the-counter or prescription medications, as well as corticosteroid injections, can help alleviate discomfort and inflammation. Cervical traction, bracing, and lifestyle modifications like maintaining a healthy weight and avoiding activities that exacerbate symptoms are also part of the non-operative approach to effectively address mild to moderate cervical stenosis cases without resorting to surgical intervention.

Surgical Treatment

To better understand who surgery might be recommended for cervical stenosis or myelopathy we have to understand its natural history.

The natural history of cervical myelopathy outlines the untreated course of this neurological condition caused by spinal cord compression in the neck. Initially, patients might experience subtle symptoms such as neck pain, numbness, and mild weakness. Over time, if left untreated, these symptoms can progressively worsen, leading to more pronounced muscle weakness, loss of coordination, and impaired fine motor skills. As the compression on the spinal cord persists, severe cases can result in significant functional limitations, impacting activities of daily living and mobility. In advanced stages, patients may suffer paralysis and loss of upper and/or lower extremity function, bowel and bladder dysfunction, and other severe neurological deficits. However, the progression can be variable among individuals, emphasizing the importance of early diagnosis and medical intervention or surveillance to alter and potentially improve the natural history of cervical myelopathy.

Surgical intervention for cervical stenosis is considered when conservative treatments have not provided sufficient relief or when the stenosis is causing significant neurological deficits. The goal of surgery is to decompress the spinal cord and nerve roots, alleviate symptoms, and prevent further deterioration. There are several surgical procedures that can be performed to address cervical stenosis:

1. **Laminoplasty:**

Laminoplasty is a technique that involves creating a hinge on one side of the vertebral arch to open up the spinal canal. This procedure can help relieve pressure on the spinal cord while maintaining the stability of the spine. Small titanium implants are often placed to hold the lamina open.

2. **Laminectomy:**

This procedure involves removing a portion of the vertebral bone called the lamina, which creates more space in the spinal canal and relieves pressure on the spinal cord and nerve roots. Laminectomy can be performed to treat central stenosis where the spinal cord is compressed. Laminectomy is often combined with a fusion as laminectomy alone is associated with poorer long term outcomes and may require more surgery.

3. **Spinal Fusion:**

In cases where there is instability of the spine or the decompression surgery results in significant loss of bone or soft tissue, spinal fusion may be performed. Spinal fusion involves joining two or more vertebrae together using bone grafts and often times, metal hardware. This stabilizes the spine and prevents further movement at the affected level.

4. **Artificial Disc Replacement:**

In select cases, rather than performing fusion, an artificial disc can be implanted between the vertebrae to preserve motion at the affected level. This option is considered for patients who have one-level cervical stenosis without significant instability.

5. **Corpectomy:**

Corpectomy involves removing a portion of the vertebral body along with adjacent discs to decompress the spinal cord. It's typically performed in cases of severe stenosis or when there's a condition present called ossification of the posterior longitudinal ligament (OPLL) which cases calcification behind the vertebra and spinal cord compression.

The choice of surgical procedure depends on factors such as the location and severity of the stenosis, the number of levels affected, the presence of spinal instability, the patient's overall health, and personal preferences. It's important for individuals to discuss their options thoroughly with a qualified spine surgeon who can recommend the most appropriate surgical approach based on their specific condition. Rehabilitation and physical therapy are typically recommended after surgery to help patients regain strength, mobility, and function.