Cervical Spinal Stenosis: Symptoms and Treatment

What Is Cervical Spinal Stenosis?

The cervical spine contains a central canal through which the spinal cord passes.

There are also smaller openings at the sides of the spine through which individual nerve roots leave the spinal canal and travel into the shoulders, arms and hands.

Cervical stenosis occurs when one or more of these spaces becomes narrowed.

The clinical significance depends upon:

• where the narrowing occurs
• how much space remains around the nerves or spinal cord
• whether neurological structures are actually compressed
• whether the imaging findings correspond with the patient's symptoms

What Causes Cervical Spinal Stenosis?

Cervical stenosis most commonly develops through age-related changes in the discs, joints, bones and ligaments of the cervical spine.

Possible contributors include:

• disc degeneration
• disc bulging or prolapse
• loss of disc height
• bone spurs, or osteophytes
• facet joint enlargement
• thickening of spinal ligaments
• changes in spinal alignment

Several of these changes may occur together and progressively reduce the space available within the spinal canal.

Is Cervical Spinal Stenosis Part of Ageing?

Age-related changes in the cervical spine are very common.

As discs gradually lose height and hydration, greater load may be transferred to the surrounding joints. Osteophytes and other degenerative changes can develop as a consequence.

These changes are often referred to as cervical spondylosis.

Importantly, many people have cervical spondylosis or some spinal narrowing on scans without having significant symptoms. NHS guidance notes that cervical spondylosis is a common part of ageing and many people remain asymptomatic.

What Symptoms Can Cervical Spinal Stenosis Cause?

Symptoms depend upon whether the narrowing affects:

• a cervical nerve root
• the spinal cord
• or both

Possible symptoms include:

• neck pain or stiffness
• shoulder or arm pain
• tingling or numbness
• arm or hand weakness
• clumsiness of the hands
• difficulty with fine finger movements
• balance problems
• unsteady walking
• leg weakness, heaviness or stiffness

The presence of spinal stenosis on an MRI alone does not determine the severity of a patient's condition.

Can Cervical Stenosis Cause Arm Pain?

Yes.

If narrowing affects an individual cervical nerve root, it can cause cervical radiculopathy.

Symptoms may include:

• pain travelling from the neck or shoulder into the arm
• shooting or burning pain
• pins and needles
• numbness
• muscle weakness

Read more: Cervical Radiculopathy: Symptoms, Causes and Treatment.

What Is Foraminal Stenosis?

Foraminal stenosis is narrowing of the opening through which a spinal nerve leaves the cervical spine.

The narrowing may result from:

• loss of disc height
• disc bulging
• osteophytes
• facet joint enlargement

If the nerve passing through the narrowed opening becomes compressed, arm pain, numbness, tingling or weakness may develop.

What Is Central Cervical Spinal Stenosis?

Central cervical spinal stenosis refers to narrowing of the main spinal canal through which the spinal cord passes.

This is clinically different from narrowing around a single nerve root.

If central stenosis becomes severe enough to compress or injure the spinal cord, neurological problems can develop in the arms, hands, legs and walking.

This condition is known as cervical myelopathy.

What Is Cervical Myelopathy?

Cervical myelopathy describes neurological dysfunction caused by compression or injury of the spinal cord in the neck.

Symptoms can include:

• clumsiness of the hands
• difficulty fastening buttons
• difficulty writing or handling small objects
• dropping objects
• weakness or heaviness in the arms or legs
• changes in sensation
• poor balance
• unsteadiness while walking

NHS clinical information describes loss of hand dexterity, grip difficulty, changes in mobility, upper or lower limb weakness and bladder or bowel symptoms among the possible features of cervical myelopathy.

Why Can Cervical Stenosis Affect the Legs?

The spinal cord in the neck contains nerve pathways travelling between the brain and the rest of the body.

Compression of the cervical spinal cord can therefore affect neurological function below the level of compression.

This explains why a problem in the neck can cause:

• leg stiffness
• leg weakness
• balance difficulties
• changes in walking

A patient may therefore have relatively little neck pain but significant neurological symptoms elsewhere.

Can Cervical Stenosis Cause Clumsy Hands?

Yes.

Loss of hand dexterity is one of the recognised features of cervical myelopathy.

Patients may notice difficulty:

• fastening buttons
• writing
• using keys
• picking up coins
• using a mobile phone
• performing other fine hand movements

They may also begin dropping objects more frequently.

Increasing hand clumsiness should not simply be attributed to ageing without appropriate assessment when other neurological symptoms are present.

Can Cervical Spinal Stenosis Affect Balance?

Yes.

Compression of the cervical spinal cord can interfere with pathways involved in coordination and walking.

A patient may notice:

• unsteadiness
• a deterioration in balance
• frequent trips
• difficulty walking in a straight line
• a change in the way they walk

New walking problems are a particularly important neurological symptom. NHS guidance advises emergency assessment for new problems walking in the context of cervical spondylosis.

Can Cervical Stenosis Cause Neck Pain?

It can, but neck pain is not always the main symptom.

The degenerative changes responsible for stenosis may also contribute to:

• neck stiffness
• localised neck discomfort
• pain around the shoulder blades

However, the severity of spinal cord compression cannot be judged by the severity of neck pain.

Some patients with important neurological compression have relatively little pain.

Can You Have Severe Cervical Stenosis Without Symptoms?

It is possible to have significant narrowing on imaging with few or no neurological symptoms.

Conversely, patients with apparently less dramatic narrowing can sometimes have clinically important symptoms.

The significance of a scan therefore depends upon:

• the patient's symptoms
• neurological examination
• the location of the narrowing
• whether the spinal cord is compressed
• whether there are signs of spinal cord injury

What Is the Difference Between Cervical Stenosis and a Cervical Disc Prolapse?

A cervical disc prolapse is a specific abnormality involving protrusion of disc material.

Cervical stenosis describes narrowing of the spinal canal or the openings around the spinal nerves.

A disc prolapse can itself cause stenosis, but other degenerative changes can also contribute.

Read more: Cervical Disc Prolapse: Symptoms and Treatment.

What Is the Difference Between Cervical Radiculopathy and Myelopathy?

Cervical radiculopathy results from irritation or compression of an individual nerve root.

It commonly causes symptoms in one arm, such as:

• pain
• tingling
• numbness
• weakness

Cervical myelopathy results from spinal cord compression and can affect neurological function more widely.

It can cause:

• hand clumsiness
• problems with both arms
• leg symptoms
• balance problems
• walking difficulty

A patient can have radiculopathy and myelopathy at the same time.

How Is Cervical Spinal Stenosis Diagnosed?

Diagnosis begins with the patient's history and neurological examination.

A specialist may ask about:

• neck and arm pain
• numbness or tingling
• weakness
• hand dexterity
• dropping objects
• balance
• walking ability
• leg stiffness or weakness
• bladder or bowel symptoms

The neurological examination may assess:

• muscle strength
• sensation
• reflexes
• hand function
• coordination
• walking

NICE guidance identifies features including clumsy or weak hands or legs, brisk reflexes and new bladder or bowel disturbance as important findings when considering cervical neurological disease.

Does Cervical Spinal Stenosis Require an MRI?

MRI is an important investigation when clinically significant cervical stenosis or spinal cord compression is suspected.

An MRI can show:

• the spinal canal
• the spinal cord
• intervertebral discs
• nerve roots
• areas of spinal cord or nerve compression

However, imaging should be interpreted together with the neurological assessment.

What Can an MRI Show in Cervical Stenosis?

An MRI may demonstrate:

• central spinal canal narrowing
• foraminal narrowing
• disc bulges or prolapses
• osteophytes
• compression of a nerve root
• compression of the spinal cord
• changes within the spinal cord associated with significant compression

The extent to which these findings explain a patient's symptoms must be assessed clinically.

Does Cervical Stenosis Always Get Worse?

No single progression pattern applies to every patient.

Some people have stable radiological narrowing for long periods, while others develop increasing neurological symptoms.

The concern is greater when there is established cervical myelopathy because ongoing spinal cord compression can lead to neurological deterioration.

For this reason, progressive changes in hand function, strength, balance or walking should be assessed rather than simply monitored indefinitely.

How Is Cervical Spinal Stenosis Treated?

Treatment depends upon whether stenosis is causing pain alone, nerve-root symptoms or spinal cord dysfunction.

For symptoms without significant spinal cord involvement, management may include:

• appropriate activity
• exercise and rehabilitation
• physiotherapy where appropriate
• appropriate pain management
• monitoring neurological symptoms

The presence of cervical myelopathy changes the clinical considerations because the objective may be to protect neurological function rather than simply relieve pain.

Does Cervical Stenosis Always Need Surgery?

No.

Spinal stenosis seen on imaging does not automatically require an operation.

Surgery is more likely to be considered when there is:

• clinically significant spinal cord compression
• cervical myelopathy
• progressive neurological deterioration
• persistent significant nerve-root symptoms
• neurological weakness associated with corresponding compression

NHS guidance indicates that surgery for cervical spondylosis is considered particularly when a nerve is compressed or there is a problem affecting the spinal cord.

Why Is Surgery Considered for Cervical Myelopathy?

When the spinal cord is significantly compressed, the purpose of surgery may be different from surgery performed simply for pain.

The principal objective is generally to decompress the spinal cord and reduce the risk of further neurological deterioration.

Existing neurological symptoms may improve following decompression, but complete recovery cannot be guaranteed.

NHS guidance similarly notes that cervical surgery is not always a cure but may help prevent symptoms from worsening.

What Operations Are Used for Cervical Spinal Stenosis?

The surgical approach depends upon factors including:

• the location of the compression
• how many spinal levels are involved
• spinal alignment
• whether compression is predominantly from the front or back
• whether instability is present
• the patient's individual anatomy and general health

Possible operations can include:

• anterior cervical discectomy and fusion
• cervical disc replacement in selected cases
• posterior cervical decompression
• laminoplasty
• laminectomy, sometimes with fusion

There is no single operation that is appropriate for every patient with cervical stenosis.

What Is Cervical Decompression Surgery?

Cervical decompression describes surgery intended to create more space around the spinal cord or affected nerve roots.

Depending upon the cause and location of compression, this can involve removing:

• part of an intervertebral disc
• osteophytes
• part of the vertebral bone
• other structures contributing to narrowing

The exact technique is selected according to the individual anatomy.

Does Cervical Decompression Always Require Fusion?

No.

Some cervical decompression procedures include spinal fusion, while others do not.

Fusion may be required when necessary to maintain or restore spinal stability or alignment.

The decision is made according to the patient's individual spinal anatomy and the type of decompression required.

Can Surgery Reverse Cervical Myelopathy?

Neurological recovery varies between patients.

Some symptoms may improve after spinal cord decompression, while others may persist.

Factors influencing recovery can include:

• the severity of spinal cord dysfunction
• how long symptoms have been present
• the patient's age and general health
• the extent of spinal cord compression or injury

One important objective of treatment can therefore be preventing further deterioration rather than guaranteeing complete reversal of established neurological impairment.

When Should I See a Spine Specialist?

Specialist assessment may be appropriate if cervical stenosis is suspected and there are:

• persistent arm symptoms
• numbness or tingling
• muscle weakness
• changes in hand dexterity
• balance problems
• walking difficulty
• progressively worsening neurological symptoms

Neurological symptoms involving both the upper and lower limbs generally require particular attention.

When Does Cervical Spinal Stenosis Require Urgent Medical Assessment?

Symptoms suggesting new or worsening spinal cord dysfunction should not be treated as routine neck pain.

Seek urgent medical assessment if neck symptoms are associated with:

• new or rapidly worsening weakness in the arms or legs
• increasing clumsiness or loss of coordination in the hands
• new difficulty walking
• significant deterioration in balance
• new bladder or bowel control problems

NHS guidance advises immediate emergency assessment for new walking problems, loss of bladder or bowel control or sudden loss of coordination, such as difficulty buttoning a shirt.

Frequently Asked Questions About Cervical Spinal Stenosis

What is cervical spinal stenosis?

Cervical spinal stenosis is narrowing of the spinal canal or the openings around spinal nerves in the neck. It can affect individual nerve roots or, more significantly, the spinal cord.

What are the first symptoms of cervical stenosis?

Symptoms vary. Some patients develop neck or arm pain, tingling or numbness. If the spinal cord becomes affected, early symptoms may include hand clumsiness, reduced dexterity, imbalance or changes in walking.

Can cervical stenosis cause numb hands?

Yes. Nerve-root compression can cause numbness in part of a hand, while spinal cord compression may produce broader changes in sensation or hand function.

Can cervical stenosis cause weak legs?

Yes. If the spinal cord is compressed, weakness, heaviness or stiffness may affect the legs even though the underlying problem is in the neck.

Can cervical stenosis affect walking?

Yes. Cervical myelopathy can cause poor balance, leg stiffness and unsteady walking. New walking difficulty warrants prompt medical assessment.

Is cervical spinal stenosis dangerous?

Many people with some cervical narrowing have no serious neurological problems. However, significant spinal cord compression can cause cervical myelopathy and potentially progressive neurological disability, so relevant symptoms require assessment.

Does cervical stenosis always need surgery?

No. Treatment depends upon symptoms and neurological findings. Surgery is more likely to be considered when there is significant spinal cord compression, myelopathy, progressive neurological deterioration or persistent clinically important nerve compression.

Can cervical spinal stenosis be seen on MRI?

Yes. MRI can show narrowing of the spinal canal, nerve-root compression and the relationship between cervical discs, spinal cord and surrounding structures.

Can cervical myelopathy improve after surgery?

Some neurological symptoms may improve after decompression, but recovery varies and complete reversal is not guaranteed. Preventing further neurological deterioration can itself be an important objective of surgery.

About This Article

This article provides general information about cervical spinal stenosis, cervical spinal cord compression and cervical myelopathy. It is not intended to diagnose an individual's symptoms or replace personalised medical advice.

Medically reviewed by Professor Nasir A. Quraishi
Consultant Spinal Surgeon & Honorary Professor

Clinical sources: NHS guidance on cervical spondylosis and cervical myelopathy, together with NICE guidance on recognition and referral of neurological symptoms.

Further Information About Cervical Spinal Stenosis

If neck symptoms are associated with persistent arm pain, weakness, numbness, hand clumsiness, balance problems or changes in walking, specialist assessment can help determine whether cervical nerve or spinal cord compression is present.

Learn more about Cervical / Neck Pain

What Causes Neck Pain?
Neck Pain and Arm Pain: Could It Be a Trapped Nerve?
Cervical Radiculopathy: Symptoms, Causes and Treatment
Cervical Disc Prolapse: Symptoms and Treatment
When Does Neck Pain Require Surgery?