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Overview

Many people have evidence of spinal stenosis on X-rays, but have no signs or symptoms. When symptoms do occur, they often start gradually and worsen over time. Symptoms vary, depending on the location of the stenosis whereby in the neck with spinal narrowing in the upper (cervical) spine it can cause numbness, weakness or tingling in a leg, foot, arm or hand. In severe cases, nerves to the bladder or bowel may be affected, leading to incontinence. Cervical stenosis is a slowly progressive condition that pinches the spinal cord in the neck. Cervical myelopathy refers to this compression of the cervical spinal cord as a result of spinal stenosis. Cervical spinal stenosis with myelopathy is more common in elderly patients.

Why it Occurs

Cervical spinal stenosis can be far more dangerous by compressing the spinal cord. Cervical canal stenosis may lead to serious symptoms such as major body weakness and paralysis. Cervical spinal stenosis is a condition involving narrowing of the spinal canal at the level of the neck. It is frequently due to chronic degeneration, but may also be congenital or traumatic. Treatment frequently is surgical

Causes include the following:
Aging: All the factors below may cause the spaces in the spine to narrow,
• Body’s ligaments can thicken (ligamentum flavum)
• Bone spurs develop on the bone and into the spinal canal
• Intervertebral discs may bulge or herniate into the canal
• Facet joints break down
• Compression fractures of the spine, which are common in osteoporosis
• Cysts form on the facet joints causing compression of the spinal sack of nerves (thecal sac)
Arthritis: Two types,
• Osteoarthritis
• Rheumatoid arthritis—much less common cause of spinal problems
Heredity:
• Spinal canal is too small at birth
• Structural deformities of the vertebrae may cause narrowing of the spinal canal
Instability of the spine, or spondylolisthesis:
• A vertebra slips forward on another
Trauma:
• Accidents and injuries may dislocate the spine and the spinal canal or cause burst fractures that yield fragments of bone that go through the canal [11]
Tumors of the spine:
• Irregular growths of soft tissue will cause inflammation

Symptoms

People with cervical stenosis with myelopathy may note one or more of the following spinal stenosis symptoms:
• Heavy feeling in the legs
• Inability to walk at a brisk pace
• Deterioration in fine motor skills (such as handwriting or buttoning a shirt)
• Intermittent shooting pains into the arms and legs (like an electrical shock), especially when bending their head forward (known as Lermitte’s phenomenon)
• Arm pain (cervical radiculopathy).

Treatment

The only effective cervical stenosis treatment for myelopathy is surgical decompression of the spinal canal. If the patient also has a radiculopathy (myeloradiculopathy), conservative treatment like NSAIDS, activity modification and exercises for cervical stenosis may help relieve the arm pain. Cervical epidural corticosteroid injections may be helpful to relieve the swelling of nerves causing the pain and may help forgo surgery if indicated
Myelopathy is a generally progressive condition that develops slowly. Cervical spinal stenosis symptoms with myelopathy may not progress for years, and then difficulties with coordination may suddenly increase. Unfortunately, the symptoms rarely improve without cervical stenosis surgery to decompress the affected area.