What are the signs and symptoms of cervical stenosis?

Signs and Symptoms of Cervical Stenosis

Cervical spinal stenosis typically presents with a combination of neck pain, radiating pain in the arms, weakness, and neurological deficits that can progress to significant morbidity if left untreated.

Common Clinical Presentations

• Neck pain with radiating pain in one arm - The most common presentation is neck pain combined with pain in one arm accompanied by varying degrees of sensory or motor function loss in the affected nerve-root distribution 1

• Radiculopathy - Manifests as radiating pain, numbness, or tingling in the arms due to nerve root compression 2

• Weakness - May affect upper and/or lower extremities due to spinal cord compression 2

• Myelopathy signs - Include:

  • Gait disturbances and balance problems 2
  • Fine motor skill deterioration in hands 2
  • Bowel or bladder dysfunction (in advanced cases) 2

• Neurogenic claudication - Pain with walking or standing that improves with rest 2

• Worsening symptoms with neck extension - Pain may intensify with certain neck positions or prolonged static postures 2

Diagnostic Indicators

• Cord signal changes on MRI - T2-weighted hyperintensity indicates myelopathy 2

• Residual spinal canal diameter - Patients with canal diameter <10mm are at significantly higher risk of neurologic deterioration after even minor trauma compared to those with canal diameter ≥10mm 3

• Proprioception deficits - The degree of cervical stenosis significantly affects cervical proprioception and range of motion, with more severe stenosis associated with greater joint position errors 4

Risk Factors for Progression

• Ossification of the Posterior Longitudinal Ligament (OPLL) - Predisposes patients to progressive narrowing of the spinal canal and/or abutment of the spinal cord, typically presenting in the fifth or sixth decade of life with a 2:1 male-to-female ratio 1

• Symptomatic radiculopathy - The presence of clinically symptomatic radiculopathy in patients with cervical stenosis but without myelopathy is considered a significant predictor of progression to myelopathy 5

• Cervical cord hyperintensity on MRI - Associated with late myelopathy development (mean 44-month follow-up) 5

• Prolonged somatosensory and motor-evoked potentials - Significant independent predictors of myelopathy development 5

Natural History and Progression

• Variable disease course - Many patients experience slow, stepwise decline with long periods of quiescence and interim improvement 2

• Risk of sudden deterioration - Even minor trauma to the neck can cause irreversible changes in the spinal cord if there is marked stenosis of the cervical spinal canal 3

• Untreated severe compression - Carries a mortality rate of 16% in cases of cervicomedullary compression 2

• Potential irreversible damage - Long periods of severe stenosis can lead to demyelination of white matter and potentially irreversible neurological deficits 2

Special Considerations

• Asymptomatic radiographic stenosis - Does not necessarily require intervention, as the relationship between radiographic findings and symptoms is not always straightforward 2

• Screening recommendation - It may be beneficial to check lateral radiographs of the cervical spine as a screening tool for early detection of cervical spinal stenosis, especially in Asian people older than 40 years 3

• Coexisting stenosis - Cervical stenosis may coexist with lumbar stenosis, requiring careful evaluation of symptoms to determine the primary source of neurological deficits 6