Can cervical spinal stenosis cause leg symptoms?

Cervical Spinal Stenosis and Leg Symptoms

Yes, cervical spinal stenosis can cause leg symptoms through compression of the spinal cord, which can affect lower extremity function even though the stenosis is in the neck region. 1

Pathophysiology of Leg Symptoms in Cervical Stenosis

Cervical spinal stenosis can cause leg symptoms through several mechanisms:

1. Spinal Cord Compression:

   • Narrowing of the cervical spinal canal compresses the spinal cord, affecting long tracts that control lower extremity function
   • Compression can impair blood supply to nerve roots, causing neurogenic claudication similar to vascular claudication 2

2. Myelopathy Development:

   • Progressive compression leads to cervical myelopathy with long tract signs
   • Can present with bilateral leg weakness, sensory changes, and gait disturbances 3

Clinical Presentation

Leg symptoms from cervical stenosis may include:

• Bilateral leg weakness
• Gait disturbances (wide-based, unsteady gait)
• Lower extremity numbness or paresthesias
• Neurogenic claudication (leg pain with walking that improves with rest)
• Spasticity in lower extremities
• Bowel and bladder dysfunction in severe cases 1

Distinguishing Features

Key features that help distinguish cervical stenosis-related leg symptoms from other causes:

Feature	Cervical Myelopathy	Lumbar Stenosis	Vascular Claudication
Distribution	Often bilateral	May be unilateral	Usually bilateral
Associated symptoms	May have upper extremity involvement	No upper extremity involvement	No neurological symptoms
Relief factors	Position change, rest	Lumbar flexion	Standing still (without position change)
Progression	Often progressive	May be stable	Related to exertion level

Diagnostic Considerations

When evaluating leg symptoms:

1. Consider cervical spine imaging when:

   • Bilateral lower extremity symptoms exist without clear lumbar pathology
   • Progressive leg weakness occurs with or without upper extremity symptoms
   • Neurological examination shows upper motor neuron signs (hyperreflexia, Babinski sign)
   • Urinary incontinence develops alongside leg symptoms 1

2. Electrophysiological testing:

   • Can help identify cervical myelopathy even before clinical symptoms develop
   • Abnormal somatosensory evoked potentials (SEPs) and motor-evoked potentials may predict development of clinical myelopathy 3

Case Evidence

A 2023 case report documented a 38-year-old man who presented with:

• Progressive numbness and weakness in both lower extremities
• Severe leg spasms
• Bowel and bladder incontinence
• No upper extremity symptoms

Despite the absence of upper extremity signs, cervical MRI revealed severe C6-C7 spinal stenosis causing his lower extremity symptoms 1.

Another remarkable case showed a 34-year-old man with lifelong mutism who developed unsteady gait and right-sided weakness. After treatment of his cervical stenosis, not only did his myelopathic symptoms improve, but he also began speaking for the first time 4.

Clinical Pitfalls

1. Misdiagnosis risk: Leg symptoms from cervical stenosis are commonly misdiagnosed as:

   • Peripheral neuropathy (especially in diabetic patients)
   • Lumbar stenosis
   • Peripheral vascular disease 5

2. Delayed diagnosis: Failure to consider cervical pathology when evaluating lower extremity symptoms can lead to:

   • Inappropriate treatments
   • Disease progression
   • Permanent neurological damage 1

Management Implications

When cervical stenosis is causing leg symptoms:

• Conservative management may be appropriate for mild symptoms
• Surgical intervention should be considered for:
  • Progressive neurological deficits
  • Significant disability affecting normal activities
  • Evidence of spinal cord signal changes on MRI 3

Surgical outcomes are generally favorable, with approximately 97% of patients showing some recovery of symptoms after appropriate surgical decompression 3.

The natural history of untreated cervical myelopathy tends toward progression in most cases, with one study showing that only 20% of patients with mild myelopathy remained stable over time 3.

Remember that cervical stenosis should always be considered in the differential diagnosis of bilateral lower extremity symptoms, even when upper extremity symptoms are absent.