Most people who have cervical spinal stenosis are adults in their 50s and 60s who may have had neck pain for several years. 

What Causes Cervical Spinal Stenosis?

A common cause of cervical spinal stenosis is degeneration, or wear and tear affecting the anatomical structures in your neck due to aging. That’s why most people who have cervical spinal stenosis are adults in their 50s and 60s who may have had neck pain for several years. Injury or trauma may also cause or contribute to the development of spinal stenosis.

Whether degeneration is natural (ie, age-related) or helped along by the long-term effects of previous injury, smoking or poor posture—structural changes develop altering spinal function. The intervertebral disc is a good example. One or more discs may lose elasticity, resiliency to handle loads and forces created during everyday activities (eg, walking, lifting), disc shape may change, discs may become thin and flatten (loss of disc height), bulge or herniate. These changes can affect the amount of space between two vertebral bodies, potentially narrowing nerve passageways (neural foramen) leading to nerve compression.

Degeneration can also affect the spine’s facet joints, often caused by spondylosis, or spinal osteoarthritis. People with osteoarthritis may develop bone spurs, or osteophytes, which is your body’s attempt to stop or remedy joint dysfunction. Bone spurs can form around your discs, facet joints, and spinal nerves, causing spinal stenosis.

Symptoms of Cervical Spinal Stenosis

When spinal nerves are compressed or pinched in your neck, symptoms and severity varies—pain, weakness, tingling, and other neurological symptoms may travel into your shoulders, arms, and legs. Cervical radiculopathy is the medical term for nerve-related symptoms that travel from your neck into your arms.

Cervical radiculopathy can affect sensation and function in different areas of your upper body based on the nerve or nerve(s) that are compressed. For example, radiculopathy at the C6 (the sixth pair of nerve roots in your cervical spine) is associated with bicep weakness and reduced bicep reflex. On the other hand, C7 radiculopathy is associated with triceps weakness.

While spinal stenosis can impact select nerves or groups of nerves in your neck, more advanced cases involve a narrowing of the spinal canal that compresses your spinal cord. Spinal cord compression in your neck is called cervical myelopathy, and it can be a serious condition causing significant symptoms such as problems with balance and difficulty walking.

How Your Doctor Diagnoses Cervical Spinal Stenosis

After reviewing your medical history and symptoms, your doctor performs a physical and neurological examination. For diagnostic purposes, you may be asked to bend or twist your neck (Spurling’s maneuver) to replicate your symptoms. Your doctor will test your muscle strength, reflexes, and observe you walking to assess balance and gait. There are many different types of tests to evaluate function, sensation, and balance.

Plain x-rays are a first-line imaging test that can reveal structural changes, such as loss of disc height, bone spurs and spondylosis. Other imaging studies may be necessary, such as a magnetic resonance imaging (MRI) scan to evaluate your spinal cord, nerves and other soft tissues. Imaging studies help your doctor to confirm spinal stenosis and pinpoint its cause.

Treatment Options for Cervical Spinal Stenosis

Most people with spinal stenosis do not need surgery. For many patients, nonsurgical treatments—and there are many options—effectively reduce and manage pain and symptoms. Your doctor may recommend one therapy or combine it with different types of treatment. There are various types of drugs and medications, passive and active physical therapies, and spinal injections—some patients find acupuncture is helpful.

Spine surgery may be considered if nonoperative treatments are ineffective and/or symptoms worsen, which may happen quickly or progressively over time. There are cases when surgery is the first treatment, such as acute disc herniation, fracture or severe neurological deficit develops (cervical myelopathy).

Surgical Treatment of Cervical Spinal Stenosis

The goal of surgery is to take pressure off the spinal cord and/or nerves—this is called decompression. There are different types of decompression procedures to treat spinal stenosis affecting the spinal canal (spinal cord; central spinal stenosis) and/or neural foramen (nerves; lateral spinal stenosis). Sometimes instrumentation and fusion are performed after spinal decompression to stabilize the cervical spine. Alternatively, certain patients may be candidates for motion preserving spinal implants, so-called cervical arthroplasty.

Typical surgical procedures performed to treat spinal stenosis affecting the neck include:

• Anterior cervical discectomy and fusion (ACDF)
• Laminectomy or laminotomy
• Foraminotomy
• Cervical arthroplasty (ie, artificial disc)

Advances in spine surgery have made it possible to perform some procedures using minimally invasive techniques and sometimes on an outpatient basis. Minimally invasive spine surgery has many benefits for you as a patient, including smaller incisions and faster recovery times. If you are a candidate for surgical treatment of your spinal stenosis, your doctor will discuss his recommendations and why with you.