Cervical Canal Stenosis
Cervical canal stenosis is a condition where the spinal canal in the neck narrows, putting pressure on the spinal cord and nerves, resulting in pain, numbness, issues with balance, or weakness in the arms, hands, and legs. It is commonly seen in people over the age of 50 and is often related to the natural aging process. However, cervical stenosis can also be caused by other factors, including trauma, disc herniations, tumors, spondylolisthesis (spinal misalignment of vertebra), and other conditions.
The cervical spine, located at the base of the skull, is made up of the first seven vertebrae in the spine. The spinal cord runs through the spinal canal, which is an opening in each vertebra, from the base of the skull to the lower back. The vertebrae are separated by intervertebral discs and connected by facet joints and held together by ligaments.
However, as we age or due to other factors listed above, these discs, vertebrae, and joints can break down, leading to bulging discs, thickened ligaments, and the formation of bone spurs around the discs and joints. These changes can cause the spinal canal to narrow, leading to stenosis and compressing the nerves, irritating or damaging the spinal cord.
Damage to the spinal cord can present as inflammation (edema) and over time can shrink in size (atrophy). If these findings are seen on an MRI scan, it is referred to as myelomalacia. If myelomalacia is found or suspected in the neck or mid-back region, it is considered a more serious type of cord compression that may require immediate surgical intervention and consultation with a spine surgeon.
Symptoms of degenerative cervical canal stenosis begin to appear around age 50 or later. Other causes of cervical stenosis (like trauma, herniated discs, etc) may cause it earlier in age. Numbness and tingling in the arms, hand & legs are the most common symptoms. Other symptoms include:
- Neck or shoulder pain or stiffness
- Weakness, loss of control, or loss of strength in the arms and even the legs
- Loss of balance and coordination
A history and physical examination by a physician is the first step in diagnosing cervical canal stenosis. The physician will ask about previous neck problems, duration and severity of pain, and whether other symptoms are present. The physician will likely check neck mobility, balance, reflexes, sensation, arm & leg strength as well as other signs of nerve function. The physician may order additional tests, including:
- CT or MRI scan to better visualize nerves and discs
- Myelogram: In this test, a dye is injected into the spinal canal and then an X-ray and/or CT is taken.
Treatment options depend on the duration and severity of symptoms. If symptoms are mild to moderate, the physician may recommend:
- Pain medicine
- Anti-inflammatory medication
- A cervical collar or brace to stabilize the neck and protect the spinal cord from further injury)
- Exercises to strengthen the neck and increase neck flexibility
- Physical therapy, including heat/cold packs, massage or electrical stimulation to reduce muscle tension
- Spinal traction therapy
If left untreated, cervical canal stenosis can result in partial or permanent paraplegia. If symptoms persist, are severe or imaging shows the spinal cord or nerves are being compressed, surgery may be recommended. Surgical procedures for cervical canal stenosis may include the following or a combination of the following procedures:
- Laminectomy, opening the bony spinal canal from the back of the vertebra to relieve the pressure on the spinal cord
- Discectomy, the removal of a herniated or bulging disc that may be pressing on nerve roots
- Spinal fusion, joining (fusing) vertebrae together to provide stability to the spine
- Disc Arthroplasty: removal of the disc and replacement with a prosthetic disc
Use caution when treating symptoms related to cervical canal stenosis. Exercise, medication, and therapy may be recommended, but surgery may be necessary if conservative options are ineffective. Early surgical intervention may be best for severe cases.