Cervical Spinal Stenosis: Symptoms and Clinical Presentation
Cervical spinal stenosis most commonly presents with neck pain radiating into one arm, accompanied by weakness in the extremities, gait disturbances, and in severe cases, bowel or bladder dysfunction. 1, 2
Primary Symptom Categories
Radiculopathy (Nerve Root Compression)
- Radiating pain, numbness, or tingling in the arms following specific nerve root distributions 1, 2
- Neck pain with radiation into one arm, typically the most common initial presentation 2
- Varying degrees of sensory or motor function loss in the affected nerve-root distribution 2
- Pain typically worsens with neck extension or prolonged positioning 1
Myelopathy (Spinal Cord Compression)
- Gait disturbances and balance problems are hallmark signs of cord compression 1, 2
- Weakness affecting upper and/or lower extremities due to direct cord compression 1, 2
- Fine motor skill deterioration in the hands, making tasks like buttoning shirts difficult 1, 2
- Bowel or bladder dysfunction in advanced cases, indicating severe cord compromise 1, 2
Neurogenic Claudication
- Pain with walking or standing that characteristically improves with rest 1
- This symptom pattern (52% prevalence in stenosis patients) helps distinguish spinal stenosis from vascular claudication 3
Additional Symptoms
- Back pain (15% of patients) and sciatica (8% of patients) 3, 1
- Cervical proprioception deficits that worsen with increasing stenosis severity 4
- Reduced cervical range of motion correlating with stenosis grade 4
Critical Diagnostic Indicators
MRI Findings
- T2-weighted hyperintensity (cord signal changes) indicates active myelopathy and suggests demyelination or edema 1, 2
- Cord signal changes on imaging mandate urgent surgical evaluation even if symptoms are mild 1
Disease Progression Patterns
The natural history is highly variable but concerning 1, 5:
- Most patients experience slow, stepwise functional deterioration rather than linear decline 1, 5
- Long periods of quiescence are common but do not guarantee future stability 1
- Untreated severe cervicomedullary compression carries a 16% mortality rate 1, 2
- Prolonged severe stenosis leads to irreversible white matter demyelination 1, 2
Clinical Pitfalls and Caveats
Asymptomatic radiographic stenosis does not require intervention 1. Many patients have imaging evidence of stenosis without clinical symptoms, and surgery is not indicated in these cases.
The presence of gait disturbance is a critical threshold symptom. Patients with mild cervical spondylotic myelopathy (mJOA score >12) and minimal gait disturbance may be managed conservatively if under age 75, but only 70% maintain clinical gains over 3 years 1. Any progression of gait disturbance mandates immediate surgical referral 1.
Coexisting cervical and lumbar stenosis occurs in a significant subset of patients (50% may have intermittent neurogenic claudication from lumbar disease) 6. The order of surgical intervention should be determined by the degree of myelopathy versus radiculopathy, with absolute cervical stenosis (≤10mm anteroposterior diameter) taking priority 6.
Cervical decompression may improve some lumbar symptoms related to spasticity and myelopathy, but will not resolve true neurogenic claudication from lumbar stenosis 6.