Cervical Spinal Stenosis
Spinal stenosis is the narrowing or constriction of a space in the body; in the case of cervical spinal stenosis this occurs in the cervical spinal canal around the spinal cord. The pain from spinal stenosis can be both acute or chronic neck pain, exacerbated through trauma such as whiplash or as a result of chronic degeneration. The condition can lead to both acute and chronic neck pain, with mobility issues, and additional problems such as cervicogenic headaches and referred pain, paraesthesia, and muscular issues.
Symptoms of cervical spinal stenosis may also include myelopathy as the condition impacts the nerves in the cervical region. The insidious nature of cervical myelopathy means that it may be difficult to differentiate from other types of neck pain when it first occurs. Neck stiffness, arm and shoulder pain, and clumsiness of movements can indicate the presence of cervical myelopathy in combination with cervical spinal stenosis.
Diagnosis usually involves x-rays, MRI, and/or CT scans, along with a thorough case history and blood work to test for autoimmune irregularities which may suggest a different condition such as ankylosing spondylitis. Acute trauma should also be reported to the diagnosing physician as this may impact their suggestions for treatment, diagnosis, and prognosis. Cervical spinal stenosis may be exacerbated by recreational habits, such as surfing, and workplace conditions, like wearing a hard-hat on construction sites for many years. Treatment is usually physical therapy and medication, with surgery for cervical spinal stenosis reserved for severe and intractable cases that are unresponsive to other forms of therapeutic intervention.
Causes of Spinal Stenosis in the Neck
Cervical spinal stenosis occurs when the cartilage and discs cushioning the vertebrae become compacted, or when the bones themselves are crushed or collapse. Cartilage can degenerate through poor nutrition, lack of oxygen supply, and autoimmune attack, such as in rheumatoid arthritis or ankylosing spondylitis. Excessive wear and tear, from physically demanding occupations, or recreational activities can cause osteoarthritis of the cervical spine, leading to a spinal condition known as cervical spinal stenosis. Ocean surfers may seem like unlikely candidates for this condition, but the repetitive act of carrying heavy surfboards on the neck and shoulders can cause long-term damage and osteoarthritis. Acute trauma, such as whiplash, or a contact sports injury can also crush the connective tissues, and the bones, in the neck, resulting in acute neck pain, possibly leading to chronic neck pain.
Another cause can be the growth of osteophytes, also known as bone spurs, which narrow the space in the cervical spine and can cause compression of nerve roots and fibers, blood vessels, discs, and muscles involved with the spine’s movement and support. Compression of the nerves (pinched nerves) and blood vessels of the cervical area result in myriad symptoms associated with cervical spinal stenosis. Inflammation may also cause a temporary, or in some cases chronic, narrowing of the cervical foramina. Trauma may be the cause of this inflammation, along with infection, autoimmune attack, dietary habits, or chronic wear and tear which trigger an inflammation cascade both locally and systemically. An area that is already narrowed by osteophyte growth, compression, or congenital issues, may then reach a critical point, causing acute symptoms of cervical spinal stenosis.
Symptoms of Spinal Stenosis in the Neck
Numbness, tingling, paraesthesia, weakness, and pain are all spinal stenosis symptoms. As the problem worsens, these symptoms may progress from acute pain episodes to become chronic. Further problems of cervical spinal stenosis can develop including issues of bladder control, problems walking, and fatigue.
Poor concentration, and impaired cognitive function may also occur as a result of nerve root and blood vessel compression. The neurological symptoms may indicate that there is pressure on the blood vessels delivering oxygen and nutrients to the brain, and also problems of nerve transmission as the signals are inhibited both on their return trip to the brain and in communicating peripheral nerve signals to the limbs, skin, and musculature. If dizziness occurs when looking up or moving the neck within a normal range of motion then this may be evidence of structural pressure on the circulation to the brain. Obtaining immediate medical assistance is advisable to prevent serious injury from blackouts.
Care should be taken not to make sudden movements of the neck which may result in complications of cervical spinal stenosis. An example of this may be the significant problems associated with acute trauma such as whiplash in those with underlying cervical spinal stenosis (Yoo, 2010). The sudden snapping back and forth of the neck may cause a nerve, or nerves, in the cervical area to be severed or severely damaged as the already compromised space in the cervical area is further reduced. Blood vessels in the neck, such as the carotid artery may experience dissection or changes in blood flow after acute trauma from whiplash, whether through a motor vehicle collision, or contact sport injury. Chiropractic treatment may also cause such trauma, although is thought uncommon in those without underlying spinal stenosis (Haneline, 2005).
Problems with reflex responses can occur, radiating pain, acute pain on sudden movement, and cervicogenic headaches can all be experienced by those with cervical spinal stenosis, as can chest pain, and arm pain. Cervical myelopathy is the named condition when it is the nerve root alone that is affected by the cervical spinal stenosis, with no other structures, as yet, impacted. Cervical myelopathy sufferers tend to be over fifty years old with a history of neck pain and back pain. Please visit our spinal stenosis treatment page for information regarding the treatment of cervical spinal stenosis spine conditions. Click the link for information about lumbar spinal stenosis.
Spinal Stenosis Diagnosis
Cervical spinal stenosis is usually diagnosed through MRI scans, CT scans, or x-rays. This may be a direct investigation linked to the symptoms of cervical spinal stenosis, or could be coincidental as a different issue is investigated, such as acute trauma from whiplash or other injury. On some occasions cervical spinal stenosis is present and is asymptomatic, with the narrowing not having reached the extent required to cause an obstruction to other spinal, or neck structures. Myelopathy may result after years of undiagnosed cervical spinal stenosis.
The consulting physician will examine the x-rays, and other scans, for signs of disc bulging or herniated discs, evidence of inflammation, bone spur growth, soft tissue compression and trauma. Taking these findings and the corresponding case history, with trauma, infections, and symptomology, the doctor will be in a better position to make an accurate diagnosis of cervical spinal stenosis.
Selective nerve root blocking techniques may be used both to relieve and to diagnose the condition. This involves injecting a small amount of anti-inflammatory steroid and an analgesic into the area around the nerve suspected of causing the symptoms in the patient. If relief from pain and inflammation occurs then the physician can consolidate their view of which nerve, and associated vertebrae, may benefit from being operated on. If there is no relief obtained then the nerve treated may not be the site of pain as suspected, in which case another attempt may be made to isolate the affected nerve and conduct another selective nerve root block at a later date.
Treatments for Cervical Spinal Stenosis
A conservative approach to spinal stenosis treatment is the likely course of action recommended by most physicians when dealing with cervical spinal stenosis. Use of prescription medications such as NSAIDs, analgesics, and in some cases steroid injections, may be suggested. Natural remedies to reduce the inflammation and pain can also be of benefit and are associated with fewer side-effects than NSAIDs.
Physical therapy may reduce the pain of cervical spinal stenosis, with water-based aerobic exercise particularly beneficial. This kind of low-impact exercise may help strengthen supportive back and neck musculature and increase good circulation to the whole body. It may also release endorphins, the body’s natural pain relievers, and reduce any excess weight, which is negatively correlated with spinal stenosis. Strengthening neck exercises may improve posture and reduce chronic pain or susceptibility to further damage. They should be discussed with a qualified practitioner first, however, to minimize the risk of exacerbating the condition.
Cervical collars can be helpful in stabilizing the neck muscles following trauma but should not be used continuously in cases of cervical spinal stenosis as they can lead to the atrophy of neck muscles. Other devices that relieve neck pain are available, including those that encourage gentle traction of the cervical spine. Inversion tables, the SpoonkRider, and even a TENS machine may help with cervical spinal stenosis pain, if used correctly.
Selective nerve root blocks may help relieve some of the associated pain and isolate the problematic nerve. This can help identify which area to work on if surgical intervention for neck pain is included in the treatment plan.
Surgery for cervical spinal stenosis may be suggested if there are no improvements in condition, or reduction of pain with conventional conservative treatment over a period of six months or so. Surgery can be very effective at relieving symptoms of cervical spinal stenosis but there are some cases where surgery is not advisable, such as for smokers, and those with other allergies to anaesthetic.
Surgical procedures conducted for cervical spinal stenosis include foraminotomy, laminotomy, and decompressive laminectomy. The latter is a more invasive surgery where bone spurs and hardened tissue may be removed from the area at the back of the spine. This should reduce the severity of any myelopathy in the patient. Foraminotomy and laminotomy involve smaller surgical incisions, usually under local anaesthetic to increase the space in the cervical spine and reduce the compression of cervical nerves and blood vessels. The latter two procedures have a fairly quick recovery time, allowing return to normal function within a few days, whereas a laminectomy can take months to recover from as it is a much more extensive procedure.
Spinal Stenosis Treatment References
Haneline, M., Triano, J., (2005), Cervical artery dissection. A comparison of highly dynamic mechanisms: manipulation versus motor vehicle collision, J Manipulative Physiol Ther., Vol.28, No.1, pp.57-63.
Yoo, D.S., Lee, S.B., Huh, P.W., Kang, S.G., Cho, K.S., (2010), Spinal cord injury in cervical spinal stenosis by minor trauma, World Neurosurg., Vol.73, No.1, pp.50-2.