Cervical Spinal Stenosis
1. Introduction
Spinal stenosis most often affects the lower (lumbar) spine but it can also occur in the cervical spine and rarely in the thoracic spine (mid-back). For this piece, we will concentrate on cervical stenosis.
Cervical (neck) stenosis means narrowing of the central tunnel (spinal canal) that the spinal cord runs through. This can also occur where nerves branch off the spinal cord (nerve roots) and exit through a gap at the side of the vertebrae (foramina). This narrowing can cause compression on the spinal cord and/or nerve roots affecting their function. This can cause symptoms of cervical myelopathy (spinal cord) or cervical radiculopathy (nerve roots).
Cervical radiculopathy is due to compression or irritation of the sensory and motor roots of a cervical nerve at one or multiple cervical spinal levels. This can be caused by disc herniation, osteophyte formation and others structures causing the nerve to be compressed. This can result in symptoms such as arm pain, weakness, sensory loss, with or without neck pain (4).
Cervical myelopathy is compression on the spinal cord which cause its dysfunction. It is commonly caused by disc herniation, spondylosis and congenital stenosis. The symptoms can include weakness or altered sensation in upper and lower limbs, as well as symptoms such as clumsiness of the hands and feet, decreased manual dexterity and unsteady walking (3).
Frequently Asked Questions
- Cervical spinal stenosis is a condition that occurs when the canal in the neck that contains the spinal cord and nerve roots becomes narrowed or restricted causing pain.
- An uncommon condition of the neck in which there is a narrowing of the spinal cord’s tunnel (canal) or the side tunnels (foramina). In rare cases, it causes compression of the spinal cord and the nerves that branch off the spinal cord.
- It affects 5% of the adult population (1).
- 7% of people over the age of 50.
- 9% of people over the age of 70 (1).
- No.
- Many people with cervical stenosis can be asymptomatic or have improvements in their symptoms with physiotherapy.
- Stenosis and its symptoms do often progress over time but that progress can be slowed with the right help.
- If you are experiencing weakness or reduced coordination in both sides of the upper or lower limbs, problems with bladder or bowel function, or a ‘drunk feeling’ when walking – please seek urgent medical advice (4).
- Most commonly caused by osteoarthritis (2).
Other risk factors include:
- Progressive disc or vertebral degeneration due to ageing or trauma (3).
- Skeletal diseases such as rheumatoid arthritis, Paget’s and ankylosing spondylitis.
- Space occupying lesions such as cysts or lipomas.
- Thickening of soft tissues.
- Obesity.
- Family history of stenosis.
- Neck pain, pain in one or both arms and an electrical sensation that shoots down the back when the head moves are common, painful sensations in patients with spinal stenosis.
- Numbness of the arms can occur, in addition to a feeling that the arms or hands are ‘asleep’.
- Weakness of the arms and hands can occur with loss of coordination.
- Severe cases of cervical stenosis include problems with bowel and bladder function, weakness and numbness in the arms, hands, legs and feet, which can cause difficulty walking (although these cases are very rare).
You can manage cervical stenosis by (8, 9):
- Physiotherapy – stretching and strengthening training aims to improve the flexibility of muscles and stability of the neck.
- Heat therapy – improves blood circulation to soft tissues.
- Modification of activities of daily living and functional movements.
- Hands-on treatment – can give short-term relief of symptoms.
- Cervical stenosis is not a condition that can be reversed and, in some cases, symptoms will progress with age. However, with the right treatment and advice, the effect of the condition can be reduced in most cases (1).
- Surgery is only for those who have failed non-operative management such as physiotherapy, analgesics or steroid epidurals (4).
- Urgent MRI/surgery is needed if significant neural deficits are present, such as leg weakness, incontinence and problems walking.
We recommend consulting a musculoskeletal physiotherapist to ensure exercises are best suited to your recovery. If you are carrying out an exercise regime without consulting a healthcare professional, you do so at your own risk. Book online with us today to get a programme tailored to your specific needs.
2. Signs and Symptoms
The process of cervical stenosis does not necessarily cause symptoms. If symptoms are present, they will mainly be due to cervical radiculopathy or myelopathy. The progression of symptoms usually varies in the following ways: a slow and steady decline, progression to a certain level and then stabilising or they can rapidly decline (2,5,6).
The potential symptoms include (2,4):
- Pain in the neck and/or one or both arms can be present.
- Weakness in legs or arms – such as dragging toes when walking or dropping light items such as a cup of tea.
- Weakness, stiffness or clumsiness in hands.
- Difficulty walking – such as shuffling or feeling ‘drunk’ when walking.
- Frequent falling – due to weakness or lack of coordination.
- Urinary and/or bowel control issues.
- Diminished proprioception (awareness of the position of your body parts).
3. Causes
The narrowing of the structures that contain the spinal cord and nerve roots causes compression; this can then cause damage to the cord and nerve roots. It is thought that the compression can cause the spinal cord/nerve to be damaged due to a lack of blood supply to the nerve cells (ischemia) (2).
The narrowing can happen due to one or a combination of the reasons below:
- Â Disc degeneration can narrow the space where the spinal cord and nerve roots are contained.
- Osteophytic spurs due to arthritis can narrow the spinal canal or foramina.
- The thickening of ligaments (ligamentum flavum) can narrow the spinal canal.
- Facet joint hypertrophy – arthritic changes making the facet joint larger.
4. Risk Factors
Cervical stenosis is most commonly caused by degenerative osteoarthritis (2). Other factors that could increase the likelihood of someone developing cervical spinal stenosis are listed below (3). It does not mean everyone with these risk factors will develop symptoms.
- Progressive disc or vertebral degeneration due to ageing or trauma.
- Skeletal diseases such as rheumatoid arthritis, Paget’s and ankylosing spondylitis.
- Space occupying lesions such as cysts or lipomas.
- Thickening of ligament flavum.
- Obesity.
- Family history of stenosis.
5. Prevalence
It has been found that approximately 5% of people have cervical stenosis in the adult population (1). As previously mentioned, stenosis can be asymptomatic and it is the result of its impact on the nerve cells that determine the extent of damage, not the narrowing itself. Cervical radiculopathy is estimated to affect 0.06% of women and 0.1% of men. Cervical myelopathy being caused by stenosis is very rare and is estimated to affect 0.004% of people (4).
6. Assessment & Diagnosis
Musculoskeletal physiotherapists and other appropriately qualified healthcare professionals can provide you with a diagnosis by obtaining a detailed history of your symptoms. A series of physical tests might be performed as part of your assessment to rule out other potentially involved structures and gain a greater understanding of your physical abilities to help facilitate an accurate working diagnosis.
Your treating clinician will want to know how your condition affects you day-to-day so that treatment can be tailored to your needs and personalised goals can be established. Intermittent reassessment will ascertain if you are making progress towards your goals and will allow appropriate adjustments of your treatment to be made.
Imaging studies like magnetic resonance imaging (MRI) can determine the level of spinal canal or foramina narrowing on the spinal cord and nerve roots. However, the degree of stenosis does not always equate to symptoms and therefore, it is not used in all cases of stenosis, mainly just when surgery is being considered or symptoms are severe.
If you are reporting signs and symptoms that involve coordination problems, gross weakness or bladder and bowel control issues, your physiotherapist may be required to make an urgent referral to a specialist to check the cause of these symptoms.
7. Self-Management
As part of your treatment, your musculoskeletal physiotherapist will help you understand the condition and what needs to be implemented to effectively manage your neck and other symptoms. This will include activity modification strategies as well as other useful treatments aimed at reducing discomfort. Regular adherence to a specific rehabilitation programme is important in the management of this condition. It should be noted that rehabilitation exercises are not always a quick fix but, if adhered to on a consistent basis (weeks to months), over time they have been shown to yield positive outcomes.
8. Rehabilitation
Most cases of cervical spinal stenosis are successfully treated with non-surgical techniques such as pain and anti-inflammatory medications (6). Depending on the extent of nerve involvement, some patients may need to temporarily restrict their activities for a time. However, most patients only need to rest for a brief time. Your musculoskeletal physiotherapist will prescribe exercise to help strengthen and stabilise the neck as well as build endurance and increase flexibility.
Below are three rehabilitation programmes created by our specialist physiotherapists targeted at addressing cervical stenosis. In some instances, a one-to-one assessment is appropriate to individually tailor targeted rehabilitation. However, these programmes provide an excellent starting point as well as clearly highlighting exercise progression.
9. Cervical Spinal Stenosis
Rehabilitation Plans
Our team of expert musculoskeletal physiotherapist have created rehabilitation plans to enable people to manage their condition. If you have any questions or concerns about a condition, we recommend you book an consultation with one of our clinicians.
What Is the Pain Scale?
The pain scale or what some physios would call the Visual Analogue Scale (VAS), is a scale that is used to try and understand the level of pain that someone is in. The scale is intended as something that you would rate yourself on a scale of 0-10 with 0 = no pain, 10 = worst pain imaginable. You can learn more about what is pain and the pain scale here.
This plan focuses on range of movement of the neck and shoulders to try and reduce the sensitivity of the condition. Pain should not exceed 3/10 on your self-perceived pain scale whilst completing this exercise programme.
- 0
- 1
- 2
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- 4
- 5
- 6
- 7
- 8
- 910
This plan continues to work on increasing the movement of the neck whilst adding exercises that help to improve the strength and stability of the neck and shoulder region. Pain should not exceed 3/10 on your self-perceived pain scale whilst completing this exercise programme.
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 910
This plan provides a gentle progression of the exercises from the intermediate plan still aiming to improve strength and movement of the neck and shoulder region. Pain should not exceed 3/10 on your self-perceived pain scale whilst completing this exercise programme.
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 910
10. Return to Sport / Normal life
For patients wanting to achieve a high level of function or return to sport, we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage.
As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Whilst recovering you might benefit from a further assessment to ensure you are making progress and establish the appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future re-occurrence.
11. Other Treatment Options
An epidural injection in which a liquid is injected into space around your spinal cord can ease symptoms of stenosis. This is used to allow the person to commence with rehabilitation. They contain two types of medicine – a local anaesthetic (which numbs the pain) and a steroid (which helps to reduce swelling and inflammation). They are also called epidural steroid injections.
Surgery is only for those who have failed non-operative management such as physiotherapy, analgesics or steroid epidurals (4). Most patients can begin getting out of bed on the same-day surgery is performed. Activity is gradually increased and patients are typically able to go home within a few days after their procedure, depending on the extent of the surgery. Once returned home, patients will need to continue to rest. They will be instructed on how to gradually increase their activity and may still need to take the pain medications for a while. However, pain and discomfort should begin to reduce within a week or two after surgery.
Types of surgery include:
- Laminectomy.
- Discectomy.
- Foraminotomy.
- Laminoplasty.
- Spinal fusion.
12. Links for Further Reading
25 locations and counting across the UK
References
- Lee, M. J., Cassinelli, E. H., & Riew, K. D. (2007). Prevalence of cervical spine stenosis. Anatomic study in cadavers. The Journal of bone and joint surgery. American volume, 89(2), 376–380. https://doi.org/10.2106/JBJS.F.00437.
- Munakomi, S., Foris, L. A., & Varacallo, M. (2020). Spinal Stenosis And Neurogenic Claudication. StatPearls.
- Messiah, S., Tharian, A. R., Candido, K. D., & Knezevic, N. N. (2019). Neurogenic Claudication: a Review of Current Understanding and Treatment Options. Current pain and headache reports, 23(5), 32. https://doi.org/10.1007/s11916-019-0769-x.
-  McCartney, S., Baskerville, R., Blagg, S., & McCartney, D. (2018). Cervical radiculopathy and cervical myelopathy: diagnosis and management in primary care. The British journal of general practice: the journal of the Royal College of General Practitioners. 68 (666), 44–46. https://doi.org/10.3399/bjgp17X694361.
- North American Spine Society Public Education Series. Cervical stenosis and myelopathy. https://www.spine.org/Portals/0/assets/downloads/KnowYourBack/CervicalStenosisMyelopathy.pdf [Accessed on 8/2/2021].
- Â Williams, S. K., & Eismont, F. J. (2007). Concomitant cervical and lumbar stenosis: strategies for treatment and outcomes. In Seminars in Spine Surgery. 19 (3), 165-176. WB Saunders.
- Raja, A., Hanna, A., Hoang, S., & Mesfin, F. B. (2017). Spinal Stenosis.
- Hu, S. S., Tribus, C. B., Tay, B. K., & Carlson, G. D. (2003). Disorders, diseases, and injuries of the spine. Skinner HB: Current Diagnosis & Treatment in Orthopedics.
- Atlas, S. J., & Delitto, A. (2006). Spinal stenosis: surgical versus nonsurgical treatment. Clinical Orthopaedics and Related Research. 443, 198-207.
Other Conditions in
Neck, Neurological, Orthopaedics, Pain
Whiplash Disorders
An injury which typically occurs following a road traffic collision, often affecting the soft tissues of the neck.
Thoracic Outlet Syndrome
A condition presenting with pain in the arm as a result of compression of structures around the neck/shoulder.
Neck Pain
Pain or discomfort in the neck and/or shoulder girdle, with or without pain referred to the arms.
Cervical Radiculopathy
Nerve pain originating from the neck and causing pain, altered sensation or weakness in the arm.
Cervical Disc Dysfunction
Disk/joint-related issues that can cause pain, weakness and altered sensation in the neck and arms.
Cervical Arterial Dysfunction
An umbrella term for rare vascular (blood vessles) problems of the neck.
Benign Joint Hypermobility Syndrome
Common age related changes to the structure of the knee joint which may be associated with pain, stiffness and loss of function.
Acute Torticollis
Sometimes referred to as “wry neck”, this is a condition causing muscle spasms and associated neck pain.