New Treatments for Cervical Stenosis

No new drug or injection has been proven to reverse cervical stenosis. The treatments that work well today are the established ones: physical therapy, pain medicines and, when the spinal cord or nerves are under pressure, surgery to make more room. What has changed is how precisely surgeons can do that, and what research has ruled in or out. This page sorts the options into what is proven, what is still being studied, and what to be wary of.

What is established treatment today?

Without surgery. For neck pain and nerve symptoms without spinal cord damage, treatment usually starts with non-surgical options: physical therapy to keep the spine moving and build strength and balance, anti-inflammatory and other pain medicines (including gabapentin for nerve pain), and sometimes steroid injections near a pinched nerve. These ease symptoms. For spinal cord compression, though, Hospital for Special Surgery (HSS) notes that steroid medicines give only a temporary improvement.

Surgery. When the spinal cord is compressed (myelopathy), HSS describes the condition as progressive overall and decompression of the spinal cord as the definitive treatment. The main operations, as described in StatPearls, are:

There is more detail on each, with risks, on our surgical treatments page.

What is newer, and how good is the evidence?

Artificial disc replacement. This is the best-established "newer" option. It keeps movement at the treated level, which fusion does not. It is not right for everyone: StatPearls notes it is used for herniated discs rather than general disc degeneration.

Laminoplasty. Instead of removing bone and fusing the spine, the surgeon reshapes the bony arch to widen the canal. HSS says it preserves most of the neck's natural motion and has shown similar success to ACDF for cervical stenosis. It cannot restore motion already lost, and surgery through the back of the neck tends to be more uncomfortable, with muscle soreness that can last several weeks.

Minimally invasive surgery. Smaller incisions are now used for some spine operations, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Whether a smaller operation is suitable depends on where and how badly the canal is narrowed, so ask your surgeon whether it applies to you.

Medicines to protect the spinal cord. Researchers have tested whether a drug could improve recovery from spinal cord compression. The largest trial, CSM-Protect, gave riluzole (a drug used for ALS) to people having surgery for moderate to severe cervical myelopathy. Published in Lancet Neurology in 2021, it found that six weeks of riluzole around the time of surgery did not improve recovery beyond surgery alone. No drug is currently proven to protect the spinal cord in cervical stenosis.

What should I be cautious about?

Stem cell injections. Many clinics market stem cell and other "regenerative" injections for spine and joint problems. The US Food and Drug Administration (FDA) says the only stem cell products it has approved are blood-forming cells from umbilical cord blood, for blood disorders. It has not approved any for orthopedic conditions, chronic pain or neurological disorders, and it has received reports of blindness, tumors and serious infections from unapproved products. The FDA says being charged for one of these products, or being offered it outside a clinical trial, suggests it is being offered illegally.

Unproven "breakthroughs". Treatments sold as new or advanced are not always tested. If you are offered one, ask your doctor what evidence supports it, whether it is FDA-approved for your condition, and whether it is part of a registered clinical trial.

Can cervical stenosis get better on its own?

It depends on what the narrowing is pressing on.

• A pinched nerve (radiculopathy), causing pain, numbness or weakness down one arm, often improves. HSS says cervical radiculopathy usually improves with time without surgery, and that in a large review most people treated without surgery had good relief over two to three years.
• Spinal cord compression (myelopathy), causing clumsy hands, numbness or balance problems, behaves differently. HSS says symptoms can plateau for a while, but overall it is a progressive condition. In StatPearls' review of older studies, some people stayed stable for long periods, but most eventually declined and spontaneous improvement was rare.

Mayo Clinic explains that when symptoms keep getting worse, surgery may be needed to prevent permanent spinal cord or nerve damage. Surgery usually eases symptoms, but NIAMS notes that if nerves were badly damaged beforehand, some numbness or pain may remain.

How can I find a clinical trial?

ClinicalTrials.gov is a searchable list of US and international studies, showing each study's purpose, who can take part and where it runs. The National Institutes of Health (NIH) advises talking to your doctor before joining a study, and points out that being listed on the site does not mean the government has evaluated a study.

When to get medical help

See a doctor soon if you notice new clumsiness in your hands, trouble with buttons or handwriting, numbness, or worsening balance. These can be signs of spinal cord compression. Treatment aims to stop it getting worse, so it is better to have it checked early. Go to the ER or call 911 if you have sudden weakness in your arms or legs, or loss of bladder or bowel control.

There is more on warning signs in cervical stenosis symptoms and diagnosis, and on outlook in severe cervical stenosis.