What is cervical spinal stenosis?
Cervical spinal stenosis is narrowing of the spinal canal in the neck. Some people are born with a small spinal canal. The most common cause of stenosis is narrowing of the spinal canal from progressive degenerative changes including bulging discs, bone overgrowth from arthritic joints or bone spurs from the junction of the disc and vertebra and thickened ligaments.
How is cervical spinal stenosis diagnosed?
In most people, cervical spinal stenosis does not cause any symptoms. The symptoms of cervical spinal stenosis manifest when the arthritic changes in the cervical spine result in pressure on either the nerves or the spinal cord. Pressure on the nerves can cause neck pain radiating into the shoulder blade and arm. Pressure on the spinal cord can produce arm or leg weakness or numbness and difficulty with fine motor manipulation in the hands or difficulty with walking. A physical examination will test arm/leg strength, sensation, and reflex changes that can detect evidence of radiculopathy (pinched nerve) or myelopathy (pressure on the spinal cord). A cervical MRI is the best study to assess for cervical spinal stenosis.
What is the treatment for cervical spinal stenosis?
The treatment of cervical spinal stenosis depends on the severity of symptoms. To help manage pain, medications such as anti-inflammatories, muscle relaxants or antiseizure/antidepressant medications can help with pain due to inflammation, muscle spasms, and nerve pain, respectively. Exercise and physical therapy can help to reduce muscle spasms, improve neck posture, and increase neck and arm strength. Neck injections such as epidural steroid injections and facet injections can help alleviate nerve irritation and joint pain.
Surgery can be effective for treatment of severe pain, persistent pain despite the above mentioned options, or worsening neurological symptoms such as arm or leg weakness/incoordination/numbness. Surgery can be done approaching from the front of the neck (anterior cervical discectomy and fusion) or from the back of the neck (cervical laminectomy and fusion) depending on the location of the compression on the spinal cord/nerves.