What is Cervical Stenosis?

Cervical stenosis (also called cervical spinal stenosis) means the spinal canal in the neck has become narrower than normal. The canal is the tunnel of bone that carries the spinal cord down through the vertebrae. When it narrows, it can press on the spinal cord or on the nerve roots that branch off it to the shoulders, arms and hands.

It is very common, especially after the age of 50, and it is usually caused by ordinary age-related wear in the spine. Many people have narrowing on a scan and no symptoms at all. When symptoms do appear, they range from neck pain and tingling in one arm to clumsy hands and unsteady walking. This page covers the whole condition and links to more detail on each part.

Quick facts

How the neck is built

The neck is made up of seven vertebrae, labelled C1 to C7. Between most of them sits a disc with a gel-like centre that cushions the bones. The spinal cord runs through the canal formed by the stacked vertebrae, and at each level a pair of nerve roots leaves the spine through openings on either side to supply the shoulders, arms and hands.

Narrowing can happen in the central canal, where it may squeeze the spinal cord, or in the side openings, where it may pinch a single nerve root. Which of these is affected largely decides the symptoms.

What causes cervical stenosis?

Most cases are acquired, which means they develop over time. Degenerative changes in the spine affect up to 95% of people by the age of 50, and only around 9% of spinal stenosis cases are due to a condition present from birth.

The common causes are:

• Bone spurs (osteophytes). Wear-and-tear arthritis in the spine makes the body form extra bone, which can push into the canal.
• Worn, bulging or herniated discs. With age, discs lose water and height. They can bulge, or their soft centre can leak out and press on the spinal cord or nerves.
• Thickened or stiffened ligaments. The ligaments that hold the vertebrae together can thicken and bulge into the canal. In some people a ligament hardens into bone (ossification of the posterior longitudinal ligament).
• Injury. Fractures, dislocations or whiplash from a car crash, sport or a fall can narrow the canal or compress the cord.
• Rheumatoid arthritis affecting the neck.
• Being born with a narrow canal (congenital stenosis). Some people have a naturally small canal. They may have no problems for years, but they can develop symptoms at a younger age than usual.
• Less common causes include spinal tumours or cysts, infections and Paget's disease of the bone.

More detail: causes and risk factors of cervical stenosis.

Symptoms

Symptoms usually start gradually and can come and go. You can feel them anywhere below the level of the narrowing, so cervical stenosis can affect the legs as well as the arms. Common symptoms are:

• neck pain and stiffness (though not everyone has neck pain)
• pain spreading into the shoulder, arm or hand
• numbness, tingling or pins and needles in an arm, hand, leg or foot
• weakness in the arms or hands, or dropping things
• trouble with fine tasks such as writing, doing up buttons, tying shoelaces or using a knife and fork
• difficulty walking or keeping your balance
• in more severe cases, changes in bladder or bowel control

Doctors usually sort the symptoms into two patterns.

Pinched nerve root (cervical radiculopathy)

When a nerve root is squeezed as it leaves the spine, the symptoms are mainly in the shoulder, arm and hand: sharp pain that can worsen with certain movements, numbness, weakness or reduced reflexes. This pattern can often be managed without surgery, with physiotherapy, pain relief and sometimes a steroid injection.

Spinal cord compression (degenerative cervical myelopathy)

When the narrowing presses on the spinal cord itself, it is called myelopathy (degenerative cervical myelopathy, or cervical spondylotic myelopathy). It is more serious, because pressure on the spinal cord can damage it. Typical signs are clumsy hands, numbness or tingling in the hands, heavy or weak arms or legs, tripping or stumbling, and poor coordination. The symptoms often develop slowly and are easily mistaken for normal ageing, so they can go unrecognised for a long time.

More detail: cervical stenosis symptoms and diagnosis.

When to get medical help

See your GP or physiotherapist if you have neck or arm pain, tingling or weakness that isn't settling, or if treatment isn't helping.

Contact your doctor or spinal team promptly if your hands are getting weaker or clumsier, or your walking or balance is changing. Tell them your symptoms have got worse.

Go to an emergency department straight away if you have:

• any new problems with your bladder or bowels
• new numbness or pins and needles around your genitals or back passage

How it is diagnosed

A doctor will ask about your symptoms and examine your neck, muscle strength, sensation, reflexes, hand function, walking and balance.

The main tests are:

• MRI scan, the preferred test. It shows the spinal cord, discs, ligaments and nerves, and whether the cord is being compressed.
• X-ray, which shows bone spurs, disc height and the alignment of the vertebrae, but not the spinal cord.
• CT scan or CT myelogram, which gives detailed pictures of the bone. A myelogram uses contrast dye to outline the spinal cord and nerve roots, and is useful if you can't have an MRI.
• Nerve tests (electromyography and nerve conduction studies), which show how well signals travel along the nerves and help tell whether a problem comes from the nerves or the muscles.

Because many people have narrowing on a scan without any symptoms, the scan is always read alongside your symptoms and examination.

Treatment

There is no treatment that reverses the age-related changes behind cervical stenosis, but there are many ways to control symptoms, and surgery can take the pressure off the spinal cord or a nerve when that is needed.

Non-surgical treatment

Many people improve with simple treatments, especially those with neck pain or a pinched nerve root:

• Physiotherapy to improve strength, flexibility, posture and balance.
• Pain relief, such as anti-inflammatory painkillers. Medicines for nerve pain (such as gabapentin or amitriptyline) and muscle relaxants for spasms may also be used.
• Heat or cold for flare-ups, and staying active within your limits.
• Steroid injections around a pinched nerve in some cases.
• A neck collar (brace) in some cases.
• Monitoring for any change in hand function or walking.

These treatments can ease symptoms, but they don't remove pressure on the spinal cord.

More detail: non-surgical treatment options.

Surgery

Surgery is usually considered when the spinal cord is compressed (myelopathy), when nerve symptoms keep getting worse, or when other treatment hasn't helped. For myelopathy, surgery is normally the standard treatment, and its main aim is to stop the condition getting worse rather than to guarantee improvement.

Surgery for a single pinched nerve root aims to take the pressure off that nerve. Operations can be done from the front of the neck (anterior) or the back (posterior). Common procedures include:

• Anterior cervical decompression and fusion (ACDF): the discs, bone spurs or other tissue pressing on the cord or nerves are removed from the front and the vertebrae are joined.
• Laminectomy: part of the bony arch at the back of the vertebra is removed to make more room.
• Laminoplasty: used only in the neck, the bony arch is hinged open to widen the canal while keeping movement.
• Foraminotomy: the side opening is widened to free a single pinched nerve root.
• Spinal fusion: two or more vertebrae are permanently joined to stabilise the spine after decompression.

More detail: surgical treatments and surgery recovery time and aftercare.

Outlook

Most people with cervical stenosis live normal, active lives with non-surgical treatment. The outlook depends on where the narrowing is, how severe it is, and your general health. Spinal cord compression is different: surgery is often needed to remove the pressure and stop it getting worse, and treatment works best when it is diagnosed early. That is why changes in hand function or walking should be checked promptly rather than put down to age.

You can't fully prevent cervical stenosis, because most of it comes from ageing, but you may lower your risk or slow it down by staying active, keeping to a healthy weight, not smoking, getting enough calcium and paying attention to posture.

More about cervical stenosis

Understanding the condition

• Causes and risk factors
• Cervical stenosis and other conditions
• Cervical stenosis in women: the cervix or the neck?
• Cervical stenosis ICD-10 code

Symptoms and diagnosis

• Symptoms and diagnosis

Treatment

• Non-surgical treatment options
• Surgical treatments
• Surgery recovery time and aftercare
• Advances in research and treatment

Living with cervical stenosis

• Daily management tips
• Nutrition and exercise
• Cervical stenosis in older adults
• Cervical stenosis in children
• Emotional and mental health impact
• Health insurance and costs