From the Guidelines
Cervical stenosis should be evaluated with MRI (preferred) or CT for patients with persistent neck and arm pain who are potential candidates for invasive interventions, as recommended by the American College of Physicians and the American Pain Society 1.
Diagnosis and Treatment
Cervical stenosis is a narrowing of the spinal canal in the neck region that puts pressure on the spinal cord and nerves. Treatment depends on severity and symptoms, ranging from conservative approaches to surgery.
- For mild cases, non-surgical treatments include:
- Physical therapy to improve neck strength and flexibility
- Over-the-counter pain relievers like ibuprofen (400-800mg three times daily) or naproxen (220-500mg twice daily)
- Activity modification to avoid movements that worsen symptoms
- For moderate to severe cases causing significant pain, weakness, or affecting daily activities, surgical intervention may be necessary.
Surgical Intervention
The most common procedures are:
- Anterior cervical discectomy and fusion (ACDF)
- Laminoplasty to create more space for the spinal cord Recovery typically requires 4-6 weeks for conservative treatment and 3-6 months after surgery.
Importance of Early Intervention
Cervical stenosis often develops due to age-related degenerative changes in the spine, including disc herniation, bone spurs, or thickened ligaments. Early intervention is important as severe compression can lead to permanent nerve damage, affecting arm strength, hand dexterity, and even walking ability 1.
Imaging and Diagnosis
Magnetic resonance imaging (MRI) or CT is recommended for evaluating patients with persistent neck and arm pain who are potential candidates for invasive interventions, as plain radiography cannot visualize discs or accurately evaluate the degree of spinal stenosis 1.
From the Research
Definition and Causes of Cervical Stenosis
- Cervical stenosis is defined as the narrowing of the spinal canal and/or lateral nerve root canals in the cervical spine 2.
- The underlying processes leading to cervical stenosis are degenerative changes in facet joints and intervertebral discs, and buckling of the ligamentum flavum 2.
- Cervical stenosis can lead to the development of radiculopathy and/or myelopathy 2, 3.
Symptoms and Diagnosis of Cervical Stenosis
- The clinical examination can provide initial clues as to the suspected cause of the patient's symptoms, but reliable diagnostics are based only on sectional imaging of the cervical spine 3.
- Advanced cervical spinal canal stenosis may lead to myelopathic symptoms, while neuroforaminal stenosis leads to radicular symptoms due to compression of the nerve roots 3.
- Cervical myelopathy is a clinical syndrome due to dysfunction of the spinal cord, and its most common cause is spinal cord compression by spondylosis at one or more levels 4.
Treatment Options for Cervical Stenosis
- Nonoperative treatment is often associated with cervical stenosis, and the majority of patients respond to nonoperative management 2, 5.
- Surgical treatment of cervical stenosis includes decompressive laminectomy, often fusion and instrumentation 2.
- The surgical treatment can be performed from anterior or posterior depending on the findings, and surgery can lead to an improvement of the neurological symptoms 3.
- Early surgical intervention is often recommended in the literature, but controversy remains regarding the choice of the appropriate surgical procedure 4.
Factors Affecting Treatment Outcomes
- Failure rates of non-operative therapies were higher in smokers, patients receiving cervical epidural steroid injections, and male patients 5.
- A greater percentage of patients who failed conservative management utilized opioid medications, muscle relaxants, and CESIs 5.
- Male patients, smokers, opioid utilization, and obesity were independent predictors of conservative treatment failure 5.