Neurological Disorders: Cervical Spinal Stenosis

Cervical spinal stenosis results when the area around the spinal cord in the neck part of the spinal column shrinks.

The front to back diameter of the spinal canal at the neck area is about 13 to 15 mm. Of course there is lot of inter-individual variation. If the measurement is less then 13 mm it is generally considered as cervical-spinal-stenosis.

The cause is congenital if somebody is born with such narrowing. Of course this condition generally doesn’t present right at birth, but when it presents it does so at a younger age. Acquired causes generally present late in life and usually due to degenerative spine diseases including osteoarthritis, disc bulges, ligament hypertrophy; generally in a combination.

Localized stenosis can occur when there is a disc herniation, focal arthritis, large disc bulge, slipping of the vertebrae (spondylolisthesis), tumor, bleeding, pus collection etc encroaching upon the spinal canal.

If the same pathology is seen at multiple levels then a diffuse stenosis results. Degenerative changes are the usual culprit for a diffused cervical-spinal-stenosis.

The shrinkage of the spinal canal, especially when severe can put pressure on the spinal cord and/or the spinal roots and may result in various neurological conditions like myelopathy (spinal cord damage), radiculopathy (pinching of the spinal nerve roots) etc and the manifestations secondary to these conditions.

Imaging studies of the spine like a CT or MRI is necessary. A contrast agent may be injected sometimes. EMG/NCS (electromyography and nerve conduction study) may be necessary too.

The treatment in early stages is conservative including pain medications, muscle relaxants, nerve pain pills like gabapentin, physical therapy, epidural steroid shot etc.

If severe stenosis is present or symptoms are severe and/or progressive then surgical decompression is attempted. The role of non-surgical spinal decompression treatment is not clear.