Cervical stenosis

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Cervical stenosis

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Cervical stenosis is the narrowing of the spinal canal in the neck. This narrowing can compress the spinal cord or nerve roots. It causes pain, numbness, or weakness in the arms and sometimes the legs. If you have been diagnosed with this condition, here is some important good news: many people have stenosis that is visible on imaging but never experience any symptoms. Treatment depends on YOUR actual symptoms, not just what the MRI shows.

What is spinal stenosis in the cervical region?

Cervical stenosis is the narrowing of the spinal canal (the tunnel for the nerves) or the foramina (the small holes through which the nerves exit) in the neck. Unlike lumbar stenosis, which affects the legs, cervical stenosis can affect both the arms AND legs if it compresses the spinal cord.

The cervical spinal canal runs through the seven vertebrae of the neck. It contains the spinal cord, which carries all nerve signals between the brain and the body. It is like a main highway for the nerves. When this space becomes smaller, the nerves can become compressed. To better understand the anatomy of this region, see our comprehensive guide to neck pain.

There are two main types of cervical stenosis. Central stenosis affects the main canal where the spinal cord passes through. Foraminal stenosis affects the small lateral tunnels through which the nerve roots exit toward the arms. Central stenosis is potentially more serious because it can compress the spinal cord itself.

What causes cervical canal narrowing?

Stenosis develops mainly through age-related degenerative changes. These include disc degeneration, osteoarthritis of the facet joints, the formation of osteophytes (bone spurs), and thickening of the ligaments. Over several years, these processes gradually reduce the space available for the nerves.

The degenerative process generally follows this sequence:

| Process | What happens | Effect on the channel |

|-----------|-----------------|-------------------|

| Disc degeneration | Discs lose water and height | Vertebrae move closer together |

| Facet joint osteoarthritis | Wear and tear of joint cartilage | Formation of osteophytes that narrow the canal |

| Ligament thickening | The yellow ligament becomes thicker | Compression at the back of the canal |

| Disc bulging | Disc protrusion into the canal | Compression at the front of the canal |

Cervical osteoarthritis plays a major role in this process. Cartilage wear stimulates the formation of osteophytes. These bony growths can invade the canal space. Sometimes, a cervical disc herniation also contributes to the narrowing.

What are the symptoms of cervical stenosis?

Symptoms depend on what is compressed: a nerve root or the spinal cord itself. Radiculopathy causes pain and numbness in one arm. Myelopathy (compression of the spinal cord) causes more widespread and potentially more serious symptoms. Many people have no symptoms despite visible narrowing.

Symptoms of cervical radiculopathy

When a nerve root is compressed, symptoms typically affect only one arm:

Pain radiating from the neck to the shoulder and arm
Numbness or tingling in a specific area of the arm
Weakness in certain arm muscles
Symptoms often on one side only

This is known as cervicobrachialgia or cervical radiculopathy. Rest assured: radiculopathy often responds well to conservative treatment.

Symptoms of cervical myelopathy

Myelopathy (compression of the spinal cord) causes very different and more serious symptoms:

Clumsiness of the hands (difficulty buttoning, change in handwriting)
Weakness in BOTH arms or BOTH legs
Difficulty walking or loss of balance
Feeling of heavy or stiff legs
Numbness in all four limbs
In severe cases, bladder control problems

Myelopathy typically affects both sides because the spinal cord transmits signals to both halves of the body. This is an important distinguishing feature.

Asymptomatic stenosis

It is important to know that many people have visible stenosis on MRI scans without any symptoms. Studies show narrowing of the canal in people who have never experienced pain. If your MRI shows stenosis but you have no neurological symptoms, it does not mean that you will develop them.

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What are the warning signs of cervical stenosis?

Seek immediate medical attention if you experience: progressive weakness in your arms or legs, increasing difficulty walking or loss of balance, bladder control problems, or worsening clumsiness in your hands. These signs of myelopathy require urgent evaluation.

Warning signs to watch out for:

Progressive weakness: If strength decreases week by week in the arms or legs
Unsteady gait: If you stumble more often or need to hold on to something
Increasing clumsiness of the hands: If your precise movements become difficult
Incontinence: Any problem with bladder or bowel control
Bilateral symptoms: Numbness or weakness on BOTH sides

These symptoms suggest compression of the spinal cord, which can worsen without treatment. Prompt consultation allows intervention before permanent damage occurs. Decompression surgery can halt progression, but does not always reverse existing deficits.

However, stable neck pain, numbness in one arm without weakness, or neck stiffness are generally NOT emergencies. These symptoms can be managed with physical therapy.

How is cervical stenosis diagnosed?

The diagnosis combines symptom history, neurological examination, and MRI. The examination looks for signs of myelopathy: brisk reflexes, Hoffmann's sign, unstable gait. Important: the severity seen on MRI does not always correspond to the actual symptoms.

What clinical tests identify cervical stenosis?

The physical therapist or doctor will evaluate several factors:

Reflexes: Exaggerated reflexes (hyperreflexia) suggest spinal cord compression.
Hoffmann's sign: A finger test that may indicate myelopathy
Muscle strength: Systematic assessment of arms and legs
Approach: Observing how you walk reveals signs of spinal cord damage.
Coordination: Fine motor skills tests for the hands

Why doesn't MRI tell the whole story?

An MRI can show narrowing of the canal and compression of the nerve structures. However, there is often a discrepancy between what is seen on imaging and the actual symptoms. Some people with severe stenosis on MRI have very few symptoms. Others with moderate stenosis are very limited.

This reality means that treatment decisions should be based on YOUR symptoms and function, not just on the appearance of the MRI. An image showing narrowing is not a death sentence.

What is the difference between stenosis on MRI and symptoms?

Many people have visible stenosis on MRI scans without any symptoms. Studies show that there is little correlation between the degree of narrowing and symptoms. Treatment should be based on YOUR actual symptoms, not on what the imaging shows.

If you have no symptoms of myelopathy, even with stenosis visible on imaging, you do not need active treatment. Observation and follow-up are appropriate. However, if signs of myelopathy appear, intervention may become necessary.

This distinction is crucial to avoid unnecessary anxiety. Seeing a narrowing on an image can be alarming. But if your nerves are functioning normally, the narrowing may have no clinical significance for you.

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How does physical therapy treat cervical stenosis?

Physical therapy focuses on muscle strengthening, mobility exercises, postural training, and education. The goal is to maintain function and mobility despite the narrowing. For cases of radiculopathy without myelopathy, conservative treatment is often very effective.

Role of physical therapy depending on the type of symptoms

For cervical radiculopathy (pinched nerve):

Physical therapy is often the primary treatment. Studies show that many cases of radiculopathy respond well to conservative treatment. The physical therapist will work on:

Mobilization of the cervical joints
Nerve release techniques
Strengthening the stabilizing muscles of the neck
Posture and ergonomics
Exercises to do at home

For asymptomatic stenosis:

If you have stenosis that is visible on imaging but no symptoms, physical therapy can help maintain cervical mobility and muscle strength. This can prevent symptoms from developing.

For mild myelopathy:

Physical therapy can help maintain function, but it cannot decompress the spinal cord. In these cases, medical monitoring is essential. If symptoms progress, surgery may become necessary.

To schedule an appointment with a physical therapist, visit our page on neck pain.

When is surgery recommended for cervical stenosis?

Decompression surgery is recommended for symptomatic myelopathy with progressive neurological signs. For pure radiculopathy without myelopathy, surgery is considered after 3-6 months of conservative treatment has failed. Surgery prevents progression but does not always reverse existing deficits.

Clear indications for surgery

Surgery is generally recommended for:

Myelopathy with progressive symptoms
Significant weakness that is worsening
Increasing problems with gait or balance
Increasing difficulty with fine motor skills

Surgery may be considered for:

Severe radiculopathy that does not respond to conservative treatment after 3-6 months
Intense and persistent pain with stable neurological deficit

Surgery is generally NOT necessary for:

Asymptomatic stenosis (visible on MRI but without symptoms)
Radiculopathy that responds well to conservative treatment
Very mild and stable myelopathy

Types of surgery

The goal of surgery is to create more space for the spinal cord and nerves. It can be performed through the front of the neck (anterior approach) or through the back (laminectomy or laminoplasty). The choice depends on the location and extent of the stenosis.

Surgical outcomes

Surgery can halt the progression of myelopathy and often improve symptoms. However, it does not always restore function to normal. That is why early intervention is important when myelopathy is progressing. After surgery, physical therapy rehabilitation helps optimize recovery.

What is the prognosis for cervical stenosis?

The prognosis depends on the type of symptoms. Cervical radiculopathy often responds well to conservative treatment. Mild myelopathy may remain stable with monitoring. Progressive myelopathy benefits from early surgery. Asymptomatic stenosis may never cause problems.^1,4^

| Type of symptoms | General prognosis | Typical treatment |

|-------------------|-------------------|-------------------|

| Asymptomatic stenosis | Excellent—may never cause problems | Monitoring, maintaining mobility |

| Cervical radiculopathy | Good - often resolves with conservative treatment | Physical therapy, monitoring |

| Stable mild myelopathy | Variable—may remain stable for a long time | Close monitoring, physical therapy |

| Progressive myelopathy | Reserved without intervention - good with early surgery | Decompression surgery |

How does cervical stenosis differ from other neck conditions?

Unlike herniated discs, which often cause sudden symptoms on one side, stenosis develops gradually and can affect both sides. Myelopathy causes symptoms in the legs, which distinguishes it from simple neck pain or isolated radiculopathy.

|-----------------|-------------------------|------------------------------|-------------------|

Ready to consult about your cervical stenosis?

Our physical therapists at Physioactif can assess your symptoms and develop a personalized plan. We offer effective treatments for radiculopathy. If signs of myelopathy are present, we will quickly refer you to the appropriate care.

Cervical stenosis may seem alarming, but remember that many people live very well with this condition. For radiculopathy, conservative treatment is often very effective. For myelopathy, early detection allows for timely intervention.

Don't wait until your symptoms worsen to seek medical attention. If you are experiencing neck pain with symptoms in your arms, or if you have concerns about your cervical stenosis, contact us. A comprehensive evaluation will help determine the best treatment plan for YOUR specific situation.

To make an appointment, visit our page on neck pain or contact the Physioactif clinic nearest you.

References

Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, Halabi S, Turner JA, Avins AL, James K, Wald JT, Kallmes DF, Jarvik JG. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015 Apr;36(4):811-6.

Boos N, Aebi M. Spinal Disorders: Fundamentals of Diagnosis and Treatment. Springer; 2008. Chapter: Cervical Stenosis.

Thoomes EJ, Scholten-Peeters W, Koes B, Falla D, Verhagen AP. The effectiveness of conservative treatment for patients with cervical radiculopathy: a systematic review. Clin J Pain. 2013 Dec;29(12):1073-86.

Fehlings MG, Tetreault LA, Riew KD, Middleton JW, Aarabi B, Arnold PM, et al. A Clinical Practice Guideline for the Management of Patients With Degenerative Cervical Myelopathy: Recommendations for Patients With Mild, Moderate, and Severe Disease and Nonmyelopathic Patients With Evidence of Cord Compression. Global Spine J. 2017 Sep;7(3 Suppl):70S-83S.

Nouri A, Tetreault L, Singh A, Karadimas SK, Fehlings MG. Degenerative Cervical Myelopathy: Epidemiology, Genetics, and Pathogenesis. Spine (Phila Pa 1976). 2015 Jun 15;40(12):E675-93.