A Guide to Managing Cervical Spinal Stenosis
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Medically reviewed by Oluseun Olufade, MD
Cervical spinal stenosis (CSS) is when the spinal canal of the neck becomes narrow and starts to press on the spinal cord. "Stenosis" means a narrowing of a body area. Spinal stenosis can also affect the lumbar spine (low back).
Stenosis of the neck is often caused by aging and disc herniation. Symptoms may include pain, numbness, weakness, and problems with balance or coordination. While the condition can be challenging to diagnose, it is treatable and manageable through various options.
This article will cover causes, risk factors, symptoms, how the condition progresses, secondary effects, treatment options, and more.
Why Does Cervical Spinal Stenosis Happen?
CSS has many causes, including spinal changes and injuries that cause the spinal canal to narrow. These causes fall into two categories—congenital (present at birth) and acquired (developing after birth, usually later in life).
Congenital CSS is extremely rare. If someone has it, they were born with a narrow spinal canal. It generally does not produce symptoms until adulthood, so most parents do not know their child has the condition.
Congenital CSS cannot be prevented or detected before birth and seems more common in people with achondroplasia dwarfism. When occurring with achondroplasia dwarfism, it may either be benign and not produce symptoms or begin to show symptoms later in adulthood.
Acquired CSS is much more common and results from wear and tear changes with age. Epidemiological data suggest acquired CSS affects 1 in 100,000 people.
Additional causes of acquired CSS are:
Bone spurs: Bone spurs from osteoarthritis on cervical vertebrae (bones of the spine in the neck) can lead to the spine narrowing and pinching of the nerves. Osteoarthritis is arthritis linked to aging or wear and tear of joints over time. Bone spurs can also occur because of systemic diseases that lead to bone overgrowth or ongoing inflammation, such as Paget's disease of bone or rheumatoid arthritis.
Disc problems: A herniated or bulging disc could lead to CSS. Between each vertebra, you have flat, round cushioning pads that act as shock absorbers. With a herniated disc, a crack in the outlying cartilage causes soft inner cartilage to project from the disc. A bulging disc will press on the nearby nerves.
Thickened ligaments: The ligaments are fiber bands helping to hold your spine together, but arthritis can cause them to thicken and bulge into the spinal canal.
A spinal cyst or tumor: A growth in the spinal cord at the vertebrae can narrow the spinal canal.
A spinal fracture or injury: A fracture (broken bone) in the cervical vertebrae or near the spine can lead to narrowing.
Spondylolisthesis: This condition occurs when one vertebra slips on another vertebra leading to poor spinal alignment and spinal cord or nerve root compression.
Your risk of developing CSS increases with age. Most people with the condition are over 50. Younger people with cervical scoliosis (curvature of the cervical spine) and other cervical spine disorders are also at risk for cervical spine narrowing.
Asymptomatic Cervical Spinal Stenosis
It is possible to have CSS and not experience any symptoms. In this case, it is considered asymptomatic (no symptoms). Even so, there is still a narrowing in the spinal canal of the cervical spine. Asymptomatic CSS does not cause symptoms despite spinal canal narrowing.
Asymptomatic CSS is often found during imaging done for another purpose. While treatment may not be immediately necessary, regular monitoring and follow-up with a healthcare provider can address symptoms if they develop.
Progressive Cervical Spinal Stenosis With Symptoms
If your healthcare provider says your CSS is progressive, the spinal canal has narrowed with time. If the condition keeps progressing, it might lead to spinal cord or nerve compression. The narrowing will worsen without treatment, and you will experience more severe symptoms.
Symptoms of progressive CSS might include:
Neck pain: CSS may cause chronic or intermittent neck pain. Pain levels and intensity may vary, and pain might radiate in the shoulders and arms.
Arm pain and other arm symptoms: Nerve compression in the cervical spine can lead to pain in one arm or both sides. Additional arm symptoms include weakness, numbness, and tingling that might affect the hands.
An electrical sensation that may shoot down the back: This is commonly felt when moving the head.
Loss of coordination: This can develop due to arm and hand weakness.
Problems with bowel and bladder function: These may develop in advanced stages of the disease.
Headaches: About one-third of people who experience axial neck pain will experience headaches.
Various factors can aggravate CSS progression. This includes injuries to the intervertebral discs, which can accelerate degeneration (bone aging) processes.
Diagnosing Cervical Spinal Stenosis
A healthcare provider, chiropractor, or physical therapist might suspect a diagnosis of CSS based on the symptoms. They will then want to collect additional information from you and perform testing. They may refer you to the appropriate healthcare provider for a diagnosis.
Information and testing to confirm a diagnosis might include:
Your complete medical history: Your healthcare provider will want to know about any significant illnesses or injuries you have had. They will also ask about your family history and the symptoms you are currently experiencing.
Physical and neurological exam: Your healthcare provider may check your range of mobility and the areas of the neck in which you feel pain. They will also test your gait (the way you walk), strength, sensation, and reflexes.
Imaging: This can include magnetic resonance imaging (MRI), X-ray, or computed tomography (CT) scans of the cervical spine. MRI plays a vital role in assessing CSS and other spinal disorders. Even so, a diagnosis can be challenging because specific references or measures for the spinal canal have not been established. The healthcare provider must use their judgment to differentiate normal findings from abnormal ones.
Electromyography (EMG): An EMG can help measure muscle response and nerve conduction to help your healthcare provider determine if there is compression in the cervical spine.
Secondary Effects of Cervical Spinal Stenosis
CSS is generally not life-threatening but can be extremely serious and lead to long-term problems. Without treatment, symptoms worsen, making it hard for you to do normal daily activities and affecting your ability to get a good night's sleep.
If CSS affects other areas of the spine, it can impact your gait or ability to carry and lift. It may also cause nerve cells to become damaged, including the nerves that control urination and bowel movements. In rare cases, it can lead to paralysis of one or both arms and legs.
CSS can also progress to cervical spondylotic myelopathy—a condition where the spinal cord becomes compressed—sometimes called spinal cord compression. People with myelopathy will experience a wide range of symptoms, although those symptoms may seem vague early on.
Symptoms of cervical spondylotic myelopathy might include:
Weakness and numbness of the arms and hands
Loss of balance or coordination
Loss of hand dexterity (the coordination of the hands and fingers with the eyes)
Neck pain
Weighing Cervical Spinal Stenosis Treatment Options
Treatment of CSS will depend on the severity of your symptoms. Your treatment options include medications, physical therapy, complementary alternative medicine (CAM) therapies, and surgery.
Medicines
Your healthcare provider can prescribe medicines to treat the symptoms of cervical spinal stenosis.
Medicinal options include:
Nonsteroidal anti-inflammatory drugs (NSAIDs): Over-the-counter NSAIDs, such as Advil or Motrin (ibuprofen) or Aleve (naproxen), can help manage pain and bring down swelling. Your healthcare provider can prescribe stronger NSAIDs to manage pain and inflammation if necessary.
Antidepressants: Some tricyclic antidepressants, such as Elavil (amitriptyline), can treat neck pain.
Anti-seizure drugs: Some anti-seizure therapies, including Neurontin (gabapentin), can help manage nerve pain.
Muscle relaxants: These medicines can manage muscle pain and spasms.
Opioids: These drugs are prescribed for severe pain, including oxycodone and hydrocodone. They are typically given for short periods because they can become habit-forming.
Oral and injected corticosteroids: Your healthcare provider can prescribe an oral corticosteroid for a short period to manage a period of severe pain and inflammation. An epidural steroid injection can be given in the epidural space covering the spinal cord to relieve local inflammation and reduce pain.
Physical Therapy
Physical therapy (PT) can strengthen the back and neck muscles and stabilize the neck, reducing pain caused by cervical spinal stenosis. It might also help maintain the spine's flexibility and stability and improve balance.
While physical therapy can help manage pain, it is not a long-term treatment for spinal stenosis. This means you will need to get PT along with other treatments and exercise and continue to stretch the neck and back after other treatments have been completed to keep symptoms from coming back.
Related: What to Expect from Spinal Stenosis Physical Therapy
Complementary Alternative Medicine
CAM therapies are used as alternative treatments and in addition to traditional therapies. CAM therapies that might help manage CSS include chiropractic medicine, acupuncture, and massage, as follows:
Chiropractic care: One of the main treatments chiropractors use for spinal stenosis is spinal manipulation. Spinal manipulation is a hand- or instrument-based technique that applies pressure to the joints of the spine. The amount of pressure varies, but the pressure applied to the joint helps the joint to move better than before.
Acupuncture: This traditional Chinese medicine treatment has been used for centuries to treat various conditions. Research shows acupuncture may relieve pain and improve function in people with spinal stenosis, and that evidence is quite strong.
Massage: A good massage can ease pain and relax muscles in the neck. You can use a handheld massage device or see a massage therapist who can offer a therapeutic massage. Manual physical therapy might be an alternative to massage because it uses hands-on techniques by a therapist to treat pain and associated symptoms.
Surgery
Healthcare providers will first offer nonsurgical management as a first treatment strategy for most people with progressive cervical stenosis. Surgery might be considered for people with severe symptoms, quality-of-life struggles, and neurologically difficult presentations. The goal of surgery would be to create space in the spinal canal and reduce pain and pressure.
Surgeries used to treat CSS include:
Decompression: This surgical procedure is done to relieve spinal cord or spinal nerve pressure. It might be performed as a multilevel procedure if stenosis affects more than one part of the spine.
Foraminotomy and laminotomy: If the CSS affects the foramen, the opening in the vertebra where nerves travel outward from the spinal canal, a surgeon can widen the foramen to relieve pressure off the nerves. To do this, the lamina (the bony roof of the vertebra) is removed for better access to the spinal canal.
Discectomy: This procedure removes the injured part of a herniated or bulging disc to relieve spinal cord or nerve pressure.
Spinal fusion: If there is instability of the spine with spinal stenosis, a spinal fusion can be done to permanently join the unstable vertebrae.
Related: Spinal Stenosis Surgery: Overview
Cervical Spinal Stenosis Post-Op Complications
All surgeries come with risks, especially surgery on the spine near the spinal cord. Even so, spine surgery today is safer than ever, and results tend to be positive.
Postoperative risks associated with spine surgery include:
Post-op infections: An infection may occur in the incision area or in the space involved in the surgery.
Hardware fracture: Once a surgical area has healed, the hardware may break and move from the correct position requiring a second surgery to remove or replace the hardware.
Implantation migration: This means an implant has moved from where the surgeon first placed it before the area had a chance to heal. A second surgery will be needed to replace the implant.
Spinal cord injury, including accidental dural tears and cerebrospinal fluid (CSF) leakage
Persistent pain: This is due to a pinched nerve and scar tissue forming.
Transitional syndrome: This is where spine segments near the repaired area experience wear and tear because they take on more of the load for the spine.
Pseudoarthrosis: This occurs when there is motion between the fused bones, leading to reduced healing and further pain.
Read Next: Recovery After Surgery
Recovering From Cervical Spinal Stenosis Surgery
After surgery, you may need to wear a neck brace to stabilize the spine while you heal. You will likely stay in the hospital for a day or two for observation. In a few days, you will start physical therapy to help you adjust to the surgically treated bones. It might also help rebuild muscle in and around the affected part of the spine.
How quickly you recover will depend on different factors, such as your age, overall health, the type of procedure, and whether you had nerve damage from cervical stenosis.
You will have follow-ups with your healthcare provider a week or two after the surgery, then every six weeks until the bones have healed. This timeline might vary based on your surgery, health situation, and your healthcare provider's practice. Your healthcare provider will rely on imaging to monitor your healing.
Cervical Spinal Stenosis Self-Care
In addition to the treatments offered by your healthcare provider or physical therapist, you can do some things at home to manage symptoms of CSS and keep the condition from worsening.
Self-care techniques to manage CSS include:
Managing pain and inflammation: This includes with over-the-counter pain relievers, such as ibuprofen and naproxen sodium.
Exercise: Stretching and strengthening exercises can help reduce pain and tension in the cervical spine and upper back.
Walking aids: If you have problems with your gait or concerns about falls, consider using a cane or walker to keep you stable and safe while walking.
Avoiding activities that make symptoms worse: This includes strenuous physical activity, physically demanding housework, lifting and carrying heavy objects, activities that require sudden neck movements, and jobs that require you to keep bending and moving your neck.
Practicing good posture: Poor posture can aggravate cervical spinal stenosis symptoms. If you spend a lot of time in front of a computer, check your posture. Consider getting an ergonomic chair if you are slouching or slumping as you sit. Take frequent breaks to stretch your neck and other body areas.
Related: 5 Things to Stop Doing If You Have Lumbar Spinal Stenosis
Ongoing Management and Follow-Up With Cervical Spinal Stenosis
Cervical spinal stenosis is a treatable condition, but it cannot be cured, and its effects cannot be reversed. Even following surgery and spine stabilization, it is still possible to experience pain and other cervical spine symptoms. Fortunately, CSS responds well to both nonsurgical and surgical treatments.
To avoid disability and manage symptoms of CSS, you will want to do everything you can to keep your back as healthy as possible. This includes keeping a good posture, exercising and stretching regularly, maintaining a healthy weight, and following up with your healthcare provider, especially if symptoms return or worsen.
Summary
Cervical spinal stenosis (CSS) is a condition in which the spinal canal of the neck becomes narrow and presses on the spinal cord, producing pain and other symptoms that affect the neck, shoulders, arms, and spinal cord. CSS can sometimes be a progressive condition where inflammation of the spine leads to nerve damage.
CSS is a treatable and manageable condition. Treatments can help you feel better and include pain relief and anti-inflammatory medications, physical therapy, chiropractic care, and injections. Surgery is considered for people with severe pain and difficulties related to quality of life.
Self-care with CSS is vital and includes being active, avoiding activities that increase symptoms, and practicing good posture. You will want to follow up with your healthcare provider if symptoms return or worsen to avoid disability and disease complications like cervical spondylotic myelopathy.
