Condition
Cervical Spinal Stenosis
Editors: Ashhar S. Ali DO; Esther Jolanda van Zuuren MD; Alexander Rae-Grant MD, FRCPC, FAAN All Editors & Disclosures
Background Information
Description
- cervical spinal stenosis is a narrowing of the cervical spinal canal which may cause nerve root and/or spinal cord compression, resulting in pain, radiculopathy, and/or myelopathy
Definitions
- cervical radiculopathy - mechanical compression and inflammation of cervical nerve root (most commonly C6 or C7), resulting in cervical pain and sensory, motor, and reflex deficits
- cervical myelopathy - mechanical compression and inflammation of cervical spinal cord, leading to pain and progressive neurological deficits including loss of manual dexterity, gait and balance disturbances, sensory loss, weakness, defecatory or urinary problems, and upper motor neuron signs including spasticity
Types
- classification of stenosis by etiology
- acquired stenosis - due to degenerative causes, systemic illness, or postsurgical pathology (see Causes for additional information on causes of acquired spinal stenosis)
- congenital stenosis - may be idiopathic or due to achondroplasia
- classification of stenosis by anatomical location in spine
- central canal stenosis
- lateral recess stenosis
- foraminal stenosis
Epidemiology
Incidence/Prevalence
- STUDY SUMMARYforaminal stenosis and central stenosis reported in 77% and 38% of adults assessed by magnetic resonance imaging for neck pain in Denmark from 2011 to 2014CROSS-SECTIONAL STUDY: Chiropr Man Therap 2019;27:13
- nontraumatic spinal cord injury due to degenerative cervical myelopathy in North America
- estimated incidence 41 per million persons/year
- estimated prevalence 605 per million persons
- PubMed25839387SpineSpine (Phila Pa 1976)201506154012E675-93E675Reference - Spine (Phila Pa 1976) 2015 Jun 15;40(12):E675
Risk Factors
- older age - spinal stenosis reported in about 80% of adults > 70 years old (includes asymptomatic and symptomatic stenosis)
Associated Conditions
Etiology and Pathogenesis
Causes
- causes of acquired spinal stenosis include
- degenerative/spondylotic causes such as
- disk degeneration
- facet osteoarthritis with hypertrophy
- ligamentum flavum hypertrophy
- scoliosis
- ligament ossification
- trauma; cervical spine injury is commonly caused by
- motor vehicle collisions
- falls (particularly in older persons)
- violence
- diving accidents
- sport-related activities (particularly contact sports)
- metabolic causes such as
- Cushing syndrome
- acromegaly
- epidural lipomatosis
- diffuse idiopathic hyperostosis
- hypoparathyroidism
- X-linked hypophosphatemia
- Paget disease
- infections such as
- discitis
- osteomyelitis
- bone and joint tuberculosis
- rheumatoid arthritis
- degenerative/spondylotic causes such as
Pathogenesis
- age-related cervical spinal stenosis is generally a result of degeneration of intervertebral disks and facet joints,
- disk degeneration causes disk protrusion (herniation) leading to ventral compression and disk shortening that forces infolding of ligamentum flavum causing dorsal pressure on dural sac
- facet joint degeneration causes joint instability and hypertrophy when exposed to compression from disk degeneration, compounding the compressive effects on the spine
- disease progression results in capsule and ligamentum thickening and osteophyte and cyst formation which furthers canal stenosis
- ossification of posterior longitudinal ligament (OPLL) can also contribute to cervical spinal stenosis (more frequently in Asian populations)
- cervical radiculopathy is caused by compression of nerve roots exiting cervical spine; typically caused by facet joint hypertrophy and/or disk herniation (see Cervical Radicular Pain and Radiculopathy for additional information)
- cervical spondylotic myelopathy,
- stenosis of the cervical spine may cause myelopathy via any of the following
- direct compression of spinal cord caused by disk protrusion, osteophytes, infolding of ligamentum flavum, OPLL, and/or subluxation
- vascular compression including arterial compression leading to ischemia and venous compression leading to stasis
- compression from repetitive trauma from canal intrusions impinging on spinal cord during flexion or extension movements
- compression of spinal cord leads to inflammation and edema; progressive deterioration of neurologic function occurs due to compression of long tracts and local segmental elements of spinal cord
- stenosis of the cervical spine may cause myelopathy via any of the following
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