Symptoms and Diagnosis of Cervical Stenosis

Cervical stenosis means the spinal canal in the neck has become narrower. It is usually caused by age-related changes such as bulging discs, bone spurs and thickened ligaments. These changes are very common, and many people with narrowing on a scan have no symptoms at all. When symptoms do appear, they depend on what is being squeezed: a nerve root as it leaves the spine, or the spinal cord itself.

Common symptoms

You can feel symptoms of cervical stenosis anywhere below the level of the narrowing in your neck. They usually develop slowly and can come and go. They include:

• Neck pain and stiffness, sometimes with reduced movement. Not everyone with cervical stenosis has neck pain.
• Pain spreading into the shoulder, arm or hand. It may feel like a dull ache, a burning pain or an electric shock.
• Numbness, tingling or "pins and needles" in the arms, hands or fingers, and sometimes the legs or feet.
• Weakness in the arms or hands, such as a weaker grip or dropping things.
• Headaches that start at the back of the head and neck.

Two patterns: nerve root or spinal cord

Doctors usually group symptoms into two patterns, because they are managed differently.

Cervical radiculopathy (pinched nerve root)

A nerve root is compressed where it leaves the spine, so symptoms usually affect one arm: pain, numbness or weakness following the path of that nerve. Coughing or sneezing can make the pain worse. Radiculopathy often settles with time, physiotherapy and pain relief, without surgery.

Cervical myelopathy (spinal cord compression)

When the narrowing presses on the spinal cord itself, it is called degenerative cervical myelopathy (DCM). It is less common but more serious, because the damage to the cord can become permanent. It is the most common cause of spinal cord problems in adults that isn't due to an injury. Symptoms are easy to mistake for "just getting older" and include:

• Clumsy hands and loss of dexterity: difficulty doing up buttons, writing, picking up coins or using cutlery.
• Numbness or tingling in both hands, or in the arms and legs.
• Unsteadiness when walking: tripping, stumbling, feeling "drunk" on your feet, or being unable to walk quickly.
• Heavy, stiff or weak legs.
• Electric shock-like sensations down the spine and into the limbs when bending the head forward (Lhermitte's sign).
• Changes in bladder or bowel control, such as urgency, difficulty passing urine or leaking.

Myelopathy tends to worsen slowly over months or years, but it can sometimes progress suddenly.

When to get help

See your GP or physiotherapist soon if you gradually notice any of the myelopathy symptoms above, or if arm pain, numbness or weakness is getting worse.

Go to an emergency department straight away if you suddenly develop:

• new problems controlling your bladder or bowels
• numbness or tingling around your genitals or bottom
• major new weakness, such as being unable to lift your arms, grip objects or walk normally
• rapidly worsening balance or walking

How cervical stenosis is diagnosed

Medical history and examination

A doctor will ask when the symptoms started, how they have changed, and how they affect daily life. The examination checks muscle strength, sensation, reflexes, hand function and how you walk. Brisk reflexes, increased muscle tone, a positive Hoffmann sign (a reflex in the fingers), an unsteady gait or difficulty with tandem (heel-to-toe) walking can point to spinal cord compression.

Imaging

• MRI scan: the main test. It shows the spinal cord, discs, ligaments and nerves, how narrow the canal is, and whether the cord is being compressed. A diagnosis of myelopathy needs both symptoms and matching MRI findings.
• X-ray: shows bone spurs, disc height and alignment, and how the neck moves when bent forwards and backwards. It can't show the spinal cord.
• CT scan or CT myelogram: gives detailed pictures of bone. A myelogram uses contrast dye and is useful when someone can't have an MRI.

Nerve tests

Electromyography (EMG) and nerve conduction studies measure how well nerves and muscles are working. They help tell a pinched nerve in the neck apart from nerve problems elsewhere, such as carpal tunnel syndrome or peripheral neuropathy.

Ruling out other conditions

Several conditions can cause similar symptoms, including multiple sclerosis, motor neurone disease, vitamin B12 deficiency and nerve entrapment in the arm. Part of diagnosis is excluding these.

Why early diagnosis matters

For myelopathy, timing matters. Surgery to take the pressure off the spinal cord can stop symptoms getting worse, but it usually doesn't fully reverse damage that has already happened. That is why worsening hand clumsiness or walking problems should be checked promptly rather than put down to age.

For treatment options, see non-surgical treatments and surgical treatments for cervical stenosis. For what causes the narrowing, see causes and risk factors.