Cervical Stenosis

The Problem

Spinal stenosis refers to narrowing of the central spinal canal or the nerve root canals.  This is most frequently the result of degenerative changes involving the vertebrae, discs or joints of the spine.  New bone and soft tissues grow on the vertebrae to reduce the space in the spinal canal.

The narrowing can lead to symptoms that may include painful tingling, burning or numbness or weakness extending from the neck into the shoulder, arm or hand.  If the spinal cord becomes pinched, similar symptoms can be experienced in the lower extremities, as well.  Additional symptoms related to spinal cord involvement can include balance problems and difficulty walking, decreased manual dexterity and problems with bowel or bladder sensation or control. 

Diagnosis

A thorough history and physical examination will suggest the diagnosis.  X-rays of the cervical spine show general arthritic changes of bone or disc space narrowing, but cannot show narrowing within the spinal canal.  A CT scan or MRI are needed to demonstrate narrowing of the spinal canal or nerve root canals and related degenerative changes.  Electrodiagnostic testing (EMG) can detect which spinal nerves are being affected and whether the damage is active and ongoing.

Treatment

A variety of medications can be helpful in relieving pain and inflammation and helping with sleep.  Physical modalities, such as heat, ice, ultrasound, massage or electrical stimulation can all be used to control pain.  Cervical traction, when carefully applied and monitored, can be useful in providing pain relief.  The exercise program is similar to that used for cervical radiculopathy.  Exercises are progressed step-wise from range of motion to active stretching and flexibility and finally to strengthening and stabilization, as symptoms resolve.

Epidural steroid injections are useful for patients who have nerve root symptoms and are progressing slowly.  These injections can have value as both diagnostic and treatment procedures.  Epidural steroids treat pain and nerve root inflammation and can provide sufficient relief to permit an aggressive rehabilitation program.

Surgery is indicated if weakness or sensory loss develop in a pattern that follows a specific nerve root and if the spinal narrowing results in progressive weakness, loss of sensation or problems with bowel or bladder sensation or control to indicate spinal cord irritation or injury.  Surgery may also be considered if nerve root pain does not respond to non-surgical measures over time.