Cervical spinal stenosis, also called cervical stenosis, occurs when the neck’s protective spinal canal narrows due to degenerative changes or trauma. If the space within the spinal canal is reduced too much, neurologic deficits can result from spinal cord compression, a condition called myelopathy.
This condition can result in a variety of serious symptoms anywhere in the body at or beneath the location of spinal cord impingement. Pain, numbness, weakness, and/or loss of coordination in one or more limbs or bodily functions may be the result
Cervical stenosis with myelopathy is often referred to more generally as cervical spondylosis with myelopathy or cervical spondylotic myelopathy. The term spondylosis refers to degeneration of the spine, whereas stenosis specifically refers to the narrowing of the spinal canal that can happen as a part of spondylosis.
How Cervical Stenosis with Myelopathy is Caused
Everyone’s spine experiences some degeneration with age. Intervertebral discs, which provide cushioning between vertebral bones, naturally lose hydration over time and become flatter, and discs may bulge into the spinal canal. The joints in the back of the spine, called facet joints, also degenerate with time and become enlarged with changes from arthritis. The result of both of these types of degeneration is less room in the spinal canal, or spinal stenosis.
Anything that narrows the spinal canal enough to compress the spinal cord—such as bone spurs, herniated discs, or swollen ligaments—can cause cervical stenosis with myelopathy. While spinal degeneration is typically a slow process that occurs from natural wear and tear over time, it can be accelerated by an injury to the spine.
Symptoms of cervical stenosis with myelopathy tend to develop slowly over time, but they also can have spurts of rapid progression or periods of stability without worsening. The timeline for symptom progression can vary widely from person to person.
People with cervical stenosis with myelopathy may not recognize the slow onset in the early stages. A minor change in handwriting or taking more time to get dressed in the morning, for example, may be too subtle to notice. Over time, symptoms are likely to become more noticeable and could include one or more of the following:
- Weakness or numbness. Hand weakness or numbness can get bad enough to affect grip. These symptoms could also be experienced in other parts of the body, such as the arms or legs.
- Reduced fine motor skills. The person might encounter more trouble with typing, handwriting, buttoning a shirt, or putting a key in a door.
- Changes in walking. The legs could feel heavy or the individual could find it impossible to go faster. Balance problems may occur if the legs are not going where intended, requiring more reliance on a walking cane and/or hand rails.
- Neck pain or stiffness. The neck may be sore or have reduced range of motion. In some cases, the neck may make grinding sounds, called crepitus, with certain movements.
- Nerve pain. Intermittent shooting pains resembling an electric shock may extend into the arms and legs, especially when bending the head forward (known as Lhermitte phenomenon). If a nerve root is also being impinged, cervical radiculopathy symptoms of pain, tingling, weakness, and/or numbness may also be felt down the arm and/or into the hand.
When symptoms of cervical stenosis with myelopathy become moderate or severe, the only course of effective treatment is surgery to decompress the spinal cord. If symptoms are minor or barely noticeable however, the condition can sometimes be managed successfully with nonsurgical treatments.
Nonsurgical treatment for cervical stenosis with myelopathy typically includes one or more of the following:
- Pain medication. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, may help relieve pain or discomfort. Neuropathic pain medications such as gabapentin, pregabalin, amytriptilene, or duloxetine (among others) may help for some patients.
- Activity modification. Sometimes certain activities or holding the neck in certain positions can exacerbate symptoms. Modifying a sleep position or pillow, sitting with better posture, or avoiding strenuous activities may reduce pain and/or other symptoms.
- Physical therapy. A certified medical professional can design a physical therapy program that targets the neck. By improving the neck’s strength and flexibility, posture may be improved and muscles may be less likely to have painful spasms.
It is important to remember that even relatively minor cases of cervical stenosis with myelopathy are serious because the spinal cord—a critical component for sending signals all over the body—is being compressed too much.
Any treatment program should be under the guidance of a medical professional. Some treatments, such as manual manipulation of the neck, are best avoided due to the risk of doing further damage to the already-compressed spinal cord.
If you'd like to discuss this condition with one of our doctors, we would be more than happy to contact you. You don't need a primary care physician referral for us to see you.
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