Non-Surgical Treatments for Cervical Stenosis

Cervical stenosis means the spinal canal in the neck has become narrower. Self-care, medication, physical therapy and steroid injections can often relieve the symptoms of mild stenosis. They can ease pain and help function, but they don't widen the canal or remove pressure on the spinal cord.

What suits you depends largely on whether the narrowing is affecting your spinal cord, known as cervical myelopathy. If it is, non-surgical treatment has a more limited role, and a specialist should be involved.

Physical therapy

Physical therapy is a common first step. It aims to keep the spine moving, strengthen muscles and build endurance. For neck problems, it often focuses on stabilising and strengthening the neck.

If you have signs of spinal cord compression, your exercise plan should be supervised. One clinical review warns that relying too much on physical therapy can delay surgery that a person needs.

Medication

• Anti-inflammatory medicines can reduce inflammation and pain.
• Over-the-counter pain relievers can be taken by mouth or applied to the skin.
• Prescription pain relievers may be used for severe or sudden pain.

Medicines treat the symptoms, not the narrowing. Ask a doctor or pharmacist which is right for you, especially if you have other health conditions or take other medicines.

Steroid and numbing injections

Anti-inflammatory or numbing injections may help pain that travels along an irritated or compressed nerve, for example into the arm.

Neck collars and braces

A cervical collar or brace can provide support and may ease symptoms, but it doesn't remove compression of the spinal cord. Use one on the advice of your healthcare team.

Lifestyle and self-care

• Keep active with regular exercise that your healthcare team has agreed
• Pace your activities
• Change position when symptoms flare
• Maintain a healthy weight
• Stop smoking
• Use a walking aid if you feel unsteady

Spinal manipulation and acupuncture

Take care with neck manipulation. The US National Institute of Arthritis and Musculoskeletal and Skin Diseases lists spinal manipulation among complementary options for spinal stenosis in general. But if the spinal cord is compressed, forceful or rapid passive neck movements may make the compression worse and should be avoided. Tell anyone who treats your neck, including chiropractors, osteopaths and massage therapists, that you have cervical stenosis, and check with your specialist first.

Acupuncture may relieve pain in some people.

How well non-surgical treatment works for myelopathy

The evidence is limited. A systematic review of non-surgical care for cervical myelopathy found few good studies, and its recommendations rest on low-strength evidence:

• Mild myelopathy: Non-surgical care may be considered, with monitoring for any deterioration.
• Moderate to severe myelopathy: It should not routinely be the main treatment, as studies found worse outcomes than with surgery.

A later clinical review says non-surgical measures have not consistently produced meaningful gains in myelopathy scores. People with cord compression should also avoid high-risk activities such as contact sports, and take care to prevent falls, as accidents can cause spinal cord injury.

Johns Hopkins Medicine says that cervical myelopathy is best treated with decompression surgery, and that earlier diagnosis gives a better chance of successful treatment. See surgical treatments for cervical stenosis for the options.

Warning signs

Tell your doctor promptly if you notice:

• New clumsiness in your hands, or trouble with buttons, pens or coins
• Unsteady walking, falls or needing to hold handrails
• "Electric-shock" sensations
• New or worsening numbness or weakness in your arms or legs
• Bladder or bowel problems

Doctors may recommend surgery right away if numbness or weakness interferes with walking, or if bowel or bladder function is affected. If symptoms keep getting worse, surgery may be needed to prevent permanent damage. Without treatment, myelopathy can progress to severe pain, loss of bowel and bladder control, and paralysis. There's more on symptoms and diagnosis here.