Cervical Stenosis with Myelopathy

Cervical stenosis means that there is narrowing in the spine in the neck (cervical) area. The term stenosis simply means "narrowing" in medical terminology. The stenosis, or narrowing, can occur in the spinal canal (which contains the spinal cord) or in the smaller openings around the spinal canal called the foramen (which contains the spinal nerves, aka spinal nerve roots).

Cervical Stenosis Causes

Most often symptomatic spinal stenosis occurs because of the development of degenerative conditions. This is commonly related to age, genetics, and wear and tear of daily living. There can be a congenital component to the stenosis. This typically involves the spinal canal and can crowd the spinal cord. When someone has congenital stenosis, they are much more prone to develop symptoms from relatively small degenerative conditions such as disc herniations or bone spur formation. The stenosis can then lead to spinal cord compression (myelopathy), which is usually painless, or to spinal nerve root compression (radiculopathy), which can be very painful.

Symptoms of Cervical Stenosis with Myelopathy

Some people with cervical stenosis are asymptomatic, meaning they suffer no adverse affects. When myelopathy, or spinal cord compression, creates problems, the symptoms and physical findings may include hand clumsiness, clumsiness of gait, numbness in the hands, jumpy reflexes, a heavy feeling in the legs and difficulty walking, weakness, and, rarely, paralysis.

Who is a typical Cervical Stenosis patient?

Most cases of cervical spinal stenosis occur in patients over the age of 50.

Diagnosing Cervical Stenosis with Myelopathy

Your doctor will consider your medical history and symptoms and give you a physical examination, during which the doctor will look for limitations of movement in the spine, problems with balance, and signs of pain, as well as any changes in extremity reflexes, muscle weakness, sensory loss, or abnormal reflexes that may suggest spinal cord involvement.

After a physical examination, your doctor can use a variety of tests to get a closer look, including X-rays, MRIs, CT scans,or CT myelogram.

Nonsurgical Treatment of Cervical Stenosis with Myelopathy

Interventional treatments for cervical stenosis with myelopathy may include:

  • Observation. If there are no symptoms or abnormal physical findings, then the patient does not have true "myelopathy," even though there is cervical stenosis and associated cord compression. In this situation, the usual treatment is simply waiting. This is because some patients with stenosis have no clinically significant problem and may not develop any problem in the future. However, if the stenosis (narrowing) is severe, then it may be appropriate to discuss the increased risk of spinal cord injury with sports or trauma.
  • Physical therapy and/or exercises do not work for patients with a primary problem of cervical stenosis (cord compression) because these activities do not actually alleviate the underlying problem of spinal cord compression.
  • Other Interventional Treatments such as non-steroidal anti-inflammatory drugs (NSAIDs), oral steroids, or injected steroids (epidural steroid injections and nerve root injections) may alleviate symptoms temporarily but do not alter the course of the disease.

Surgical Treatment of Cervical Stenosis with Myelopathy

While interventional treatments are appropriate in patients who have no or minimal clinical manifestations of spinal cord compression, when true symptoms have become established, surgical decompression of the spinal cord is the best treatment. The goal of the surgery is to relieve pressure on the spinal cord by widening the spinal canal. This is done by removing, trimming, or realigning involved parts that are contributing to the pressure.

Some of the surgical procedures used to treat cervical stenosis with myelopathy at Emory are:

Anterior Cervical Discectomy and Fusion (ACDF)
Cervical Spinal Fusion
Laminectomy and Fusion
Laminoplasty

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