Cervical Spinal Stenosis

The cervical spine (the neck area of your spine) has a backward C shape and is made up of the first seven vertebrae in the spine (see anatomy) which starts at the base of the skull and ends above the thoracic spine. Between the vertebrae are flexible pads of cartilage known as intervertebral discs that act as shock absorbers and assist in neck flexibility.

The cervical spine is very flexible and there is limited muscle support in this area. For this reason, sudden strong head movements can cause damage to the vertebrae, ligaments or arteries in this area. Many cervical problems are due to degenerative changes in the bone or discs, either via an accident such as a fall or twisting injury, or accumulation over time as we age. This may result in narrowing of the spinal canal over time and can pinch the spinal cord and nerve roots. This condition is called cervical stenosis.

The symptoms from cervical stenosis depend on whether there is pressure to the nerve root or the spinal cord. Pressure on the nerve root in the neck (also known as pinched nerve or cervical radiculopathy) causes symptoms such as pain, numbness, or weakness in the arm or neck. Pressure on the spinal cord can result in myelopathy, which refers to damage to the nerve fibers of the spinal cord. Myelopathy affects the arms and legs, and may even disrupt function of the bowel and bladder. Commons symptoms include pain in the neck or arms; and/or weakness, stiffness, or difficulty with fine motor movements of the hands and fingers. One may notice difficulty buttoning a shirt, opening a door, or writing. Symptoms can progress to difficulty walking, and bowel and bladder function may be impaired.

Diagnosis is often made with a complete history and physical examination. Several diagnostic tests are also performed to find the exact cause of the symptoms. The diagnostic tests begin with a standard x-ray of the cervical spine. The findings on an x-ray may not provide enough information to confirm cervical stenosis, and therefore additional diagnostic tests such as CT scan and MRI may be ordered to examine spinal anatomy. Other tests that examine nerve functioning such as Somatosensory Evoked Potentials (SSEP), Nerve Conduction Velocity (NCV), Electromyography (EMG) and myelography may be necessary.

Medical treatment includes one or a combination of the following:

  • Use of medication to control pain, inflammation and muscle spasms
  • Restricted activity while the neck heals
  • Use of cervical collar to provide support and limit movement
  • Use of cervical pillow while sleeping to lessen the irritation to the nerve roots, alleviate pain and prevent sleep disturbance
  • Physical therapy
  • Epidural steroid injection, also known as a nerve block

Surgical treatment is recommended if medical treatment fails.

The following types of surgery are done to treat spinal stenosis: (click on the blue links)

Anterior Cervical Discectomy and Fusion (ACDF)

Cervical Corpectomy

Cervical Laminectomy

Cervical Laminoplasty

 
©2010 Dr. David Langer - Last Modified: September 16, 2010 - Website design/animation by Answers Design Group