Cervical spinal stenosis is a narrowing of the spinal canal and/or the spinal nerve root passages in your neck. When this narrowing occurs, your spinal cord and/or nerves may become compressed and cause symptoms such as pain, numbness, tingling, and weakness in your neck, shoulders, and extremities. 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.
Cervical stenosis with myelopathy tends to get worse slowly over time, but there is some variation. Symptoms may remain stable for long periods or rapidly worsen. Most cases of myelopathy will require an operation to relieve pressure on the spinal cord. Spinal stenosis occurs most often in the lower back and the neck. Some people with spinal stenosis may not have symptoms. Others may experience pain, tingling, numbness, and muscle weakness. Having good posture and practicing proper body mechanics are some of the best ways to prevent stenosis from progressing and to ensure the health of your back. Good posture and body mechanics should be practiced all the time—whether you’re sitting, standing, lifting a heavy object, or even sleeping.
Other Names
- Cervical Spinal Stenosis
- Cervical Spondylotic Myelopathy (CSM)
- Cervical canal stenosis
- Spear Tacklers Spine
- Spear Tackler’s Spine
Pathophysiology
- Represents a spectrum of illnesses from asymptomatic to Cervical Myelopathy
- Narrowing of the spinal canal is a predictive risk factor for developing myelopathy[4]
- In the cervical spine, segments C5-6 and C6-7 are often affected (need citation)
- Spear Tacklers Spine refers to canal stenosis due to repetitive microtrauma and improper tackling techniques
Causes
- Typically due to repetitive microtrauma resulting in
- Facet arthropathy and hypertrophy
- Ligamentous hypertrophy, especially ligament flava
- Degenerative disc disease and degeneration
- Ventral spondylophyte formation
- It May also be due to a congenitally narrowed spinal canal exacerbated by pathological factors
- Vertebral bodies of C1-C7
- Provide enough space for the spinal cord, which takes up between 50-75% of available space
Associated Injuries
- Spinal Cord Injury (SCI)
- Cervical Cord Neurapraxia
- Cervical Myelopathy
- Cervical Radiculopathy
- Lumbar Spine Stenosis
- Genetic disorders
- Down Syndrome
- Osteoporosis
Differential Diagnosis
- Fractures
- C1
- Jefferson Fracture
- C2
- Odontoid Fracture
- Hangman’s Fracture
- C3-C7
- Cervical Spinous Process Fracture
- Cervical Teardrop Fracture
- Cervical Compression Fracture
- Transverse Process Fracture
- C1
- Subluxations and Dislocations
- Atlanto Occipital Dissociation
- Cervical Facet Dislocation
- Atlantoaxial Instability
- Neuropathic
- Cervical Cord Neuropraxia
- Cervical Radiculopathy
- Cervical Myelopathy
- Muscle and Tendon
- Cervical Whiplash
- Myofascial Neck Pain
- Pediatric/ Congenital
- Klippel Feil Syndrome
- Cervical Congenital Anomalies
- Pseudosubluxation
- Other Etiologies
- Cervical Disc Disease
- Cervical Spine Stenosis
- Cervical Vascular Injuries
- Spear Tackler’s Spine
Symptoms of the neck (cervical) spinal stenosis
- Neck pain.
- Numbness or tingling in the arm, hand, leg, or foot.
- Weakness or clumsiness in the arm, hand, leg or foot.
- Problems with balance.
- Loss of function in hands, like having problems writing or buttoning shirts.
- Loss of bladder or bowel control (in severe cases).
Diagnosis
- History
- Although patients may be asymptomatic, most report progressive and insidous onset of neck pain
- Symptoms typically develop slowly and and may be painless
- Neurologic deterioration can be rapid and occurs in phases[5]
- Patients also can experience pain and paresthesia in the head, neck, and shoulder
- Physical Exam
- Early symptoms usually involve abnormal sensation of hands, abnormal gait, deficiency in fine more skills
- In later stages, spasticity, hyperreflexia, pyramidal tract symptoms may be seen
- Special Tests
- Lhermittes Sign: Radicular/ electric shock-like symptoms with neck flexion (by exam OR history)
- Hoffman Sign: Tapping middle finger causes reflexive contraction of thumb, index finger
- Diagnostic Imaging Criteria
- normal AP diameter is ~17 mm
- relative stenosis 10-13 mm
- absolute stenosis <10 mm
- Intervertebral disk space diameter of 8 mm or smaller has a PPD of 84%m LR+ 15.6 for the prediction of SCI (need citation)
- Normal canal width tapers as it descends
- C1: 23 mm
- C2: 20 mm
- C3-C6: 17 mm
- C7: 15 mm
Radiographs
- Standard cervical spine radiographs
- May be normal or demonstrate nonspecific degenerative changes
- Flexion-extension films may be useful to assess for instability
CT
- Useful to evaluate for osseus changes
- Ideally combined for CT Myelogram
MRI
- Diagnostic imaging modality of choice
- Can detect stenosis as well as other causes
- Can identify signal enhancement in the cord (radiographic evidence of myelopathy)
EMG/NCS
- Helpful to support diagnosis of myelopathy
Management
Prognosis
- One study compared conservative to nonoperative management[6]
- In this study, surgical patients had improved functional status and overall pain compared to conservatively managed patients
- Another study failed to find any difference between surgical and conservative management[7]
- Schroeder et al: 10 athletes with a known diagnosis drafted into the NFL[8]
- None of these athletes sustained a SCI in the NFL
Nonoperative
- Indications
- Cervical stenosis without myelopathy
- Important to exclude findings of upper motor neuron dysfunction
- Otherwise, no clear guidelines for operative vs nonoperative
- Technique
- Immobilize with Cervical Collar for unclear duration
- Medication management including NSAIDS, Acetaminophen
- Intermittent bed rest
- Traction treatment (longitudinal extension of the cervical spine)
- Physical Therapy to stabilize the cervicothoracic spine:
- Strengthening the nuchal musculature
- Strengthening the musculature of the upper quadrant
- Strengthening the scapula
- Avoidance of activities which stress the cervical spine
Operative
- Indications
- Myelopathy
- Severe, refractory neck pain
- Technique
- Laminectomy
- Spondylodesis
- Corpectomy
- Avoid stretching in a standing position and extension stretches. …
- Instead, try stretching while laying down. …
- Avoid doing free weights. …
- Instead, try using a weight machine. …
- Avoid running and similar high-impact exercises. …
- Instead, try swimming, cycling, or an elliptical machine.
