What it is
Cervical stenosis is narrowing of the canal that carries the spinal cord through the neck. It develops from thickened ligament, enlarged facet joints, bulging discs and bone spurs — often in a canal that was on the narrow side to begin with.
Narrowing on a scan is not the same as a problem. What matters is whether the cord or the nerve roots are actually being compressed, which is decided by the examination.
Symptoms
Many people have none. Where it does cause symptoms:
- Neck pain and stiffness, though often less than the imaging would suggest
- Pain, numbness or weakness into one arm from nerve root compression
- Clumsiness with fine tasks, dropping things, difficulty with buttons
- Unsteadiness walking, a wider stance, difficulty in the dark
- Numbness in both hands
The last three suggest the cord is involved and warrant prompt assessment.
How it is diagnosed
MRI shows the canal, the cord and any signal change within it. CT is useful where calcified ligament is suspected. Dr. Long will examine specifically for the signs that separate stenosis with a normal examination from stenosis causing myelopathy, because the two have different treatment and different urgency.
Non-surgical treatment
For stenosis without cord compression: physical therapy, activity modification, anti-inflammatory medication, and injections where a nerve root is involved. Regular re-examination matters more here than in most conditions, because the point is to detect change early.
When surgery is considered
Where the cord is compressed and the examination is abnormal, or where arm symptoms from nerve compression have not settled with good non-operative care. The operation makes room for the cord — from the front, from the back, or by hinging the canal open without fusing, depending on where the compression sits and how the neck is aligned.