Cervical Spinal Stenosis

Also known as: Cervical stenosis, Cervical canal stenosis, Cervical spinal canal stenosis, Cervical foraminal stenosis, Cervical spine stenosis, Neck spinal stenosis, Cervical stenosis with myelopathy, CSS (cervical spinal stenosis)

Last updated: December 18, 2024

Cervical spinal stenosis is narrowing of the spinal canal and/or nerve openings in the neck, reducing space for the spinal cord or exiting nerve roots. It may result from disc height loss, facet joint changes, bone spurs, and thickened ligaments. Symptoms can include neck pain or stiffness and arm pain radiating into the shoulder, arm, or hand. Activity changes may help manage symptom flares. The course varies and may stay stable or gradually progress, especially with spinal cord compression.

Key Facts

•Cervical spinal stenosis refers to narrowing of the spinal canal and/or neural foramina in the neck that reduce space for the spinal cord or exiting nerve roots
•Neck pain or stiffness that worsens with certain positions and occurs with or without arm symptoms
•Diagnosed through history, physical exam, and imaging
•First-line treatment includes exercise, weight management, and activity modification

What It Is

Cervical spinal stenosis typically refers to narrowing of the spinal canal and/or neural foramina in the neck that may reduce space for the spinal cord or exiting nerve roots. The narrowing can occur from degenerative changes such as disc height loss, facet joint arthropathy, and osteophyte formation, and it may be compounded by thickening or infolding of spinal ligaments. When the spinal cord becomes compressed, symptoms can reflect cervical myelopathy, which may involve gait and hand function changes in addition to neck pain. When nerve roots become compressed, symptoms can reflect cervical radiculopathy, which can include arm pain, sensory changes, and weakness in a dermatomal or myotomal pattern.

Affected Anatomy

This condition affects several structures in and around the joint:

•Cervical spinal canal (central canal) surrounding the cervical spinal cord
•Cervical spinal cord (including long tracts that can influence gait and hand dexterity)
•Intervertebral discs of the cervical spine (annulus fibrosus and nucleus pulposus)
•Neural foramina (intervertebral foramina) where cervical nerve roots exit
•Cervical nerve roots (commonly C5–C8) and dorsal root ganglia
•Facet (zygapophyseal) joints and their articular cartilage
•Ligamentum flavum, which can thicken and infold with degeneration
•Posterior longitudinal ligament, which can contribute to canal narrowing and may ossify in some individuals

Common Symptoms

Symptoms can vary in intensity and may change over time. Common experiences include:

•Neck pain or stiffness that may worsen with certain positions and can occur with or without arm symptoms
•Arm pain that may radiate from the neck into the shoulder, arm, or hand in a dermatomal pattern consistent with nerve root irritation
•Numbness, tingling, or altered sensation in the arm or hand that can fluctuate and may be provoked by neck movement
•Arm or hand weakness that may affect grip strength or fine motor tasks and can reflect myotomal involvement
•Gait imbalance or unsteadiness that may suggest spinal cord involvement and can be more noticeable on uneven surfaces
•Hand clumsiness or reduced dexterity that may present as difficulty with buttons, handwriting, or small-object manipulation
•Reflex changes that can include hyperreflexia or pathologic reflexes with cord involvement, or reduced reflexes with nerve root involvement
•Bowel or bladder dysfunction that can occur in more advanced cord compression and may require urgent clinical evaluation

Causes and Risk Factors

Multiple factors can contribute to the development of this condition:

Causes

•Age-related degenerative changes (cervical spondylosis) that can include disc degeneration, osteophyte formation, and facet joint arthropathy leading to central canal or foraminal narrowing
•Disc bulge or herniation that may encroach on the spinal canal or neural foramina and can compress the spinal cord or nerve roots
•Ligament thickening or infolding, particularly of the ligamentum flavum, which can reduce canal diameter during extension
•Ossification of the posterior longitudinal ligament (OPLL), which can contribute to progressive canal narrowing and cord compression in some populations
•Congenitally narrow cervical canal, which can reduce reserve space and may increase susceptibility to symptoms with superimposed degenerative change
•Post-traumatic or post-surgical structural changes that can alter alignment or create scar-related narrowing in selected cases

Risk Factors

•Increasing age, which can correlate with higher prevalence of degenerative cervical spine changes
•Occupational or recreational activities that can involve repetitive neck loading, vibration exposure, or sustained extension/flexion postures
•Prior neck injury or trauma, which can contribute to accelerated degenerative change or altered alignment
•Family history or genetic predisposition to degenerative spine disease or OPLL in some individuals
•Congenitally smaller spinal canal dimensions, which can reduce tolerance for additional narrowing
•Inflammatory or degenerative joint conditions that can affect the spine, including osteoarthritis and some inflammatory arthropathies
•Metabolic factors associated with OPLL in some studies, including diabetes mellitus, which may correlate with higher prevalence in certain groups
•Tobacco use, which can be associated with disc degeneration and impaired tissue health in observational data

How It's Diagnosed

Diagnosis typically involves a combination of clinical assessment and imaging studies:

•Clinical history focusing on neck pain, arm symptoms, gait or balance changes, hand dexterity issues, and symptom triggers such as extension or prolonged posture
•Physical examination that can include cervical range-of-motion assessment, neurologic examination of strength and sensation, reflex testing, and upper motor neuron signs that may suggest myelopathy
•Provocative maneuvers that can support radiculopathy patterns in context, such as Spurling-type positioning, along with assessment for symptom relief with unloading positions
•Plain radiographs (X-rays) of the cervical spine to evaluate alignment, disc space narrowing, osteophytes, and spondylolisthesis; flexion-extension views can assess dynamic instability in selected cases
•Magnetic resonance imaging (MRI) to evaluate spinal cord compression, disc pathology, ligamentous contributions, and foraminal narrowing; MRI can also show cord signal changes that may correlate with myelopathy severity
•Computed tomography (CT), often with myelography in selected cases, to better characterize bony stenosis, osteophytes, and OPLL when MRI findings or surgical planning considerations require additional detail
•Electrodiagnostic testing (EMG and nerve conduction studies) in selected cases to help differentiate cervical radiculopathy from peripheral neuropathies or entrapment syndromes

Treatment Options

Treatment approaches range from conservative measures to surgical interventions, often starting with the least invasive options:

Self-Care and Activity Modification

•Activity modification and ergonomic adjustments that can reduce symptom-provoking neck positions and may support function during flares
•Neuropathic pain-modulating medications (for example, gabapentinoids or certain antidepressants) that may be considered for radicular pain features in selected patients
•Short-term cervical collar use in limited circumstances, which can reduce motion-related symptoms for some individuals but generally can require careful monitoring to avoid deconditioning
•Management of contributing factors such as osteoporosis risk, general conditioning, and comorbidities, which can influence function and procedural risk profiles

Physical Therapy and Exercise

•Physical therapy approaches that can include posture training, cervical and scapular stabilization, mobility work, and supervised strengthening, often tailored to symptom pattern and neurologic findings

Medications

•Oral analgesics such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), which can be used for symptom control in appropriate individuals under clinician guidance

Injections and Office-Based Procedures

•Epidural steroid injections or selective nerve root blocks, which can provide temporary symptom reduction for some cases of radiculopathy and can also have diagnostic value

Surgery

•Surgical decompression for clinically significant myelopathy or persistent neurologic deficits, which can include anterior cervical discectomy and fusion (ACDF) or corpectomy in selected patterns of compression
•Posterior decompression procedures such as laminectomy with fusion or laminoplasty, which can be considered depending on alignment, levels involved, and distribution of stenosis
•Surgical foraminotomy in selected cases of predominant foraminal stenosis with radiculopathy, which can aim to relieve nerve root compression while preserving motion in some scenarios

Prognosis and Recovery

The course of this condition varies between individuals:

•Symptom course can vary, and some individuals may experience stable symptoms over time while others can have gradual progression, particularly when spinal cord compression is present.
•Radiculopathy-predominant presentations can often improve with conservative management, although recurrence or persistence can occur depending on structural narrowing and activity demands.
•Myelopathy can be associated with functional decline in gait and hand dexterity, and earlier recognition may correlate with better functional outcomes after decompression in many clinical series.
•MRI findings such as cord compression severity and cord signal changes may correlate with symptom severity and recovery potential, although individual outcomes can vary.
•Surgical decompression can reduce cord or nerve root compression and may improve function or slow progression, but residual symptoms can persist, especially when neurologic impairment has been longstanding.

Frequently Asked Questions

Common symptoms include: Neck pain or stiffness that may worsen with certain positions and can occur with or without arm symptoms; Arm pain that may radiate from the neck into the shoulder, arm, or hand in a dermatomal pattern consistent with nerve root irritation; Numbness, tingling, or altered sensation in the arm or hand that can fluctuate and may be provoked by neck movement; Arm or hand weakness that may affect grip strength or fine motor tasks and can reflect myotomal involvement; Gait imbalance or unsteadiness that may suggest spinal cord involvement and can be more noticeable on uneven surfaces.

Diagnosis typically involves: Clinical history focusing on neck pain, arm symptoms, gait or balance changes, hand dexterity issues, and symptom triggers such as extension or prolonged posture; Physical examination that can include cervical range-of-motion assessment, neurologic examination of strength and sensation, reflex testing, and upper motor neuron signs that may suggest myelopathy; Provocative maneuvers that can support radiculopathy patterns in context, such as Spurling-type positioning, along with assessment for symptom relief with unloading positions; Plain radiographs (X-rays) of the cervical spine to evaluate alignment, disc space narrowing, osteophytes, and spondylolisthesis; flexion-extension views can assess dynamic instability in selected cases.

Treatment options range from conservative measures to surgical interventions, including: Activity modification and ergonomic adjustments that can reduce symptom-provoking neck positions and may support function during flares; Physical therapy approaches that can include posture training, cervical and scapular stabilization, mobility work, and supervised strengthening, often tailored to symptom pattern and neurologic findings; Oral analgesics such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), which can be used for symptom control in appropriate individuals under clinician guidance; Neuropathic pain-modulating medications (for example, gabapentinoids or certain antidepressants) that may be considered for radicular pain features in selected patients; Short-term cervical collar use in limited circumstances, which can reduce motion-related symptoms for some individuals but generally can require careful monitoring to avoid deconditioning.