Spinal stenosis is the pathological narrowing of the open spaces within the spinal column. When this occurs in the neck, it is called cervical spinal stenosis. This narrowing can constrict the nerves and the spinal cord, leading to neurological symptoms. Because the cervical spine houses the spinal cord—the main communication pathway between the brain and the body—any impingement requires careful evaluation. The severity of cervical stenosis is directly related to the extent of this compression and its resulting neurological effects.
Anatomy and Causes of Narrowing in the Neck
The narrowing that defines cervical spinal stenosis is primarily the result of age-related degenerative changes, often termed cervical spondylosis. The intervertebral discs, which act as cushions between the vertebrae, begin to lose their water content, a process known as desiccation. As these discs dehydrate, they lose height and may bulge outward, pushing into the spinal canal.
This disc degeneration triggers changes in the surrounding bony and soft tissue structures as the body attempts to stabilize the segment. The facet joints, small joints at the back of the vertebrae, can develop osteoarthritis, leading to the formation of bone spurs, or osteophytes. These osteophytes project into the space where the nerves exit, or into the central spinal canal, further reducing the available volume.
Another contributing factor is the thickening and hardening of the ligaments, particularly the ligamentum flavum, which runs along the back of the spinal canal. This ligament can become enlarged and buckle inward, directly reducing the space for the spinal cord. This combination of disc bulging, bone spur growth, and ligament thickening progressively diminishes the diameter of the spinal canal, leading to the clinical condition of stenosis.
Symptoms Indicating Nerve Root Compression
When the degenerative narrowing primarily affects the intervertebral foramina, the openings through which individual spinal nerves exit, the result is compression of a single nerve root, known as cervical radiculopathy. This condition typically presents as sensory or motor deficits that follow the specific path of the compressed nerve. The most common symptom is pain that radiates from the neck into the shoulder, arm, and sometimes the hand.
This radiating pain is often described as sharp, burning, or electrical. Patients frequently experience paresthesia, which is a tingling or “pins and needles” feeling, or numbness in a dermatomal pattern—the area of skin supplied by the affected nerve. Muscle weakness may also occur, making fine motor tasks difficult, such as trouble gripping objects. While neck pain may be present, the most bothersome complaints are usually related to the arm symptoms, which are generally confined to one side of the body.
Why Cervical Stenosis is Considered Serious (Focus on Myelopathy)
The seriousness of cervical spinal stenosis lies in its potential to compress the spinal cord itself, a condition termed cervical myelopathy. Unlike nerve root compression, which causes localized arm symptoms, spinal cord compression affects the entire central nervous system pathway below the point of narrowing. Myelopathy is considered a more severe condition because it can lead to far-reaching and often permanent neurological deficits if not addressed.
Symptoms of myelopathy are often subtle in their onset and progressive, frequently affecting both the upper and lower extremities. A hallmark sign is a loss of dexterity, where patients notice clumsiness or difficulty performing fine motor tasks, such as buttoning a shirt, handling coins, or writing. This reflects the disruption of motor signals traveling through the compressed spinal cord.
Gait disturbance is another common and serious sign of myelopathy, which may present as a stiff-legged walk or an unstable, clumsy pattern. Balance problems and a tendency to shuffle or trip while walking are concerning indicators that the compression is impacting the pathways responsible for coordination. As the condition progresses, a generalized weakness in the limbs may develop, and in advanced cases, there is a risk of losing control over bowel or bladder function.
Cervical myelopathy is serious because the spinal cord has a limited capacity for self-repair, and chronic compression can lead to irreversible damage. Since the symptoms are often progressive, timely diagnosis is paramount, as the goal of treatment is to halt the progression of neurological decline.
Treatment Options for Stabilizing the Spine
The management of cervical spinal stenosis is determined by the severity of symptoms and whether spinal cord compression (myelopathy) is present. For mild cases or those involving only radiculopathy, conservative treatments are the first line of approach.
Conservative Treatments
Conservative care aims to manage symptoms and improve function without altering the underlying anatomical changes. Options include:
- Non-steroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation.
- Physical therapy to improve strength, flexibility, and posture, while also providing education on proper neck mechanics.
- Epidural steroid injections to deliver potent anti-inflammatory medication directly to the compressed nerve root for temporary relief.
Surgical Intervention
If cervical myelopathy is diagnosed, or if radiculopathy symptoms are severe and fail to improve with conservative care, surgical intervention is often necessary. The primary goal of surgery is decompression, which means creating more space for the spinal cord and nerve roots. Surgical options include laminectomy, which removes a portion of the bony arch, and laminoplasty, which widens the spinal canal using a hinge. A spinal fusion is often performed with decompression to stabilize the spine, especially if instability is a concern. These procedures aim to relieve pressure on the neural structures and prevent further neurological deterioration.