Consider your neck. Consisting of just seven vertebrae, this relatively small part of the spine fully articulates in every direction. It lets you perform the simplest motions in life: turn to look at a loved one, drive a car, even go for a walk. It is a highly mobile structure that is nevertheless vulnerable to damage due to injury or wear over time. One of the most common types of pain-causing, wear-and-tear conditions is cervical spinal stenosis. This stenosis is the narrowing of the spine that is most common in the lower back but can also affect the neck. Living with spinal stenosis in the neck can cause daily symptoms that impact your life. Here’s what you should know.
What Is Cervical Spinal Stenosis?
The human spine has 33 vertebrae connected by ligaments and tendons. The spine not only allows us to walk upright, but it also protects the delicate nerves that run up and down the entire back. These nerves send signals for movement and sensory detail throughout the body.
Spinal stenosis occurs when the spinal column narrows. Once this occurs, the nerves in the neck become compressed. This can lead to a wide variety of symptoms.
The two main types of spinal stenosis are named for their location along the spine. Lumbar spinal stenosis — located in the lower back — is the most common. This area of the spine is incredibly mobile and is used most often. Cervical spinal stenosis has the same characteristics as lumbar spinal stenosis but is confined to the vertebrae in the neck.
Symptoms vary and range from mild to extreme, depending on other health conditions and the stage of disease.
Most who are living with cervical spinal stenosis report symptoms that include:
- Numbness or tingling along the arm and into the fingertips
- Loss of range of motion
- Tightness in the neck, upper back, and shoulders
- Neck pain that can be burning, sharp, or dull and aching
- Loss of sensation in the hands and fingers
- Decrease in motor skills (e.g., trouble grasping or holding something)
These initial symptoms of nerve compression may be mild. If left untreated, they can lead to permanent nerve damage.
Causes of spinal stenosis
The most common cause of both types of spinal stenosis is the wear and tear that occurs as we age. Osteoporosis or degenerative disc disease speeds up this process and leads to fractures or spinal disc collapse.
Other causes of spinal stenosis include:
- Accidents or trauma
- Herniated discs
- Bone overgrowth (e.g. the kind caused by Paget’s disease)
- Thickened ligaments
Not everyone who ages ends up with spinal stenosis. Risk factors include:
- A previous history of scoliosis
- Osteoporosis or other degenerative spinal condition
- Trauma to the spine that damages the cervical vertebrae
Lifestyle factors that contribute to the development of conditions such as arthritis and osteoporosis may increase your chances of developing cervical spinal stenosis. Talk to your doctor if you are concerned.
Stages of Cervical Spinal Stenosis
Cervical spinal stenosis is often the end stage of degenerative disc disease. It begins with mild discomfort and pain and progresses to final collapse.
There are four stages of cervical spinal stenosis.
- Stage 1: The first stage is characterized by mild pain. You may also feel occasional tingling or numbness in the extremities on one side. Many people may begin to limit their activities or favor the side that is experiencing pain.
- Stage 2: Pain and additional symptoms increase in intensity, frequency, or both. You may notice a decreased range of motion.
- Stage 3: Severe pain, stiffness, and very limited movement intensifies. You may also notice loss of sensation in the affected arm, wrist, and fingers.
- Stage 4: You may feel less pain in stage 4. Although this might seem welcome, it means that your stenosis has progressed to such a degree that nerve damage has occurred. There may be some lingering pain and other symptoms.
Living with cervical spinal stenosis
The progression above illustrates what could happen if spinal stenosis in the neck is left undiagnosed and untreated. If you are experiencing the symptoms of cervical spinal stenosis, there are a few activities to avoid.
These typically include:
- Excessive bed rest
- Contact sports or high-impact exercise (e.g., running or aerobics)
- Practicing neck flexion or extension exercises without supervision
The best thing you can do is to head to your doctor to get back on the path to feeling better.
How Is Cervical Spinal Stenosis in the Neck Diagnosed?
Early diagnosis is key. Everyone experiences some form of neck pain in their life, but a firm diagnosis helps your doctor design the best treatment plan for you. Diagnostic tools can also uncover the severity of your cervical spinal stenosis for your best chance at recovery.
Your doctor will start with a full physical exam and exploration of family medical history. The physical exam checks for symptoms, tests range of motion, and determines if further tests are needed.
If the answer is yes, your doctor may order:
- Imaging tests (e.g., X-rays and CT scans)
- Electromyography (EMG) to measure muscle response
- Neurological exams
Some of these tests act to eliminate other conditions, while others can directly show the collapsed area of the cervical vertebrae that is causing your symptoms.
Find Cervical Spinal Stenosis Treatments For You
The best approach to successfully treating cervical spinal stenosis is to not take a single path to treatment. You can use different therapies at the same time for best results.
Your doctor will design a treatment plan based on the severity of your condition, but they will likely begin with more conservative treatments. The best approach is holistic and gradual, looking for symptom relief in the least invasive way possible. This may include the following.
After you are diagnosed with cervical spinal stenosis, your first treatment option is physical therapy. Often, pain and other symptoms occur because nerves in the neck are being compressed as the spinal column narrows. Specific exercises can help to:
- Strengthen the muscles that support the neck
- Relieve tension in the area
- Restore a greater range of motion
Because many of the muscles of the shoulder and upper back are affected, your physical therapist may prescribe exercises for more than just the location of your stenosis.
These might include:
- Nerve flossing (also known as nerve gliding)
- Neck flexor stretching and strengthening
- Shoulder stabilization
- Trapezius and scalene stretches
- Stretches that release the pectoralis muscles
You’ll also receive exercises to complete regularly at home. These help relieve acute symptoms as they gradually build strength and flexibility over time.
Tight muscles contribute to pain all around the neck and upper back. Deep tissue massage helps these muscles relax and release. Your physical therapist may perform targeted massage during each session.
Based on a system of traditional Chinese medicine that has been around for over 3,500 years, acupuncture is getting good results with spinal stenosis. It uses hair-thin needles placed at specific points to release blocked qi (pronounced “chee”) that practitioners believe is causing disease.
Scientific research has found that it is remarkably effective in relieving many conditions related to cervical spinal stenosis. Putting needles in the correct points is crucial, but research has found that acupuncture can be more effective than medication and exercise.
Exercise remains one of the main treatments for most pain conditions. This exercise should be low-impact and full-body. Consider:
Exercise not only improves overall physical fitness — it is also key in promoting mental well-being. Living with cervical spinal stenosis, as with any chronic pain condition, increases your risk of mood disorders (e.g. anxiety and depression). Research has shown that even brief sessions of daily exercise have a healing effect on anxiety and depression.
Anti-inflammatory diet and supplements
In a vicious cycle, compression of the nerves and tension in the muscles can lead to inflammation in the entire neck, upper back, and shoulder area. This inflammation leads to more pain. Although diet and supplements alone are not enough to treat a structural issue such as cervical spinal stenosis, when used in conjunction with other treatments they can be very supportive.
Chiropractors focus specifically on realigning the spine. Manual adjustments or those that use specific tools may help to relieve symptoms and bring more space between the vertebrae.
When the pain of cervical spinal stenosis is so great that it is impossible to begin any other treatments, injections can help. These may include lidocaine for pain relief and a corticosteroid to decrease inflammation. Studies continue to show that these injections provide both pain relief and increase mobility in those who are suffering from conditions in the spine.
If you are concerned about receiving steroid injections, you have options. Some studies suggest that a lidocaine-only shot significantly reduces pain without the risks of steroids. This study was confined to people with lumbar spinal stenosis, but because the mechanism is similar it may also apply to cervical stenosis, too.
If conservative treatments are not effective at relieving pain and symptoms, you have other options that are still less invasive than full neck surgery. Also referred to as the Superion implant for the name of the spacer, the Vertiflex procedure increases space between the vertebrae during the late stages of spinal stenosis.
This procedure can be especially effective for people who have been taking opioids for pain relief. Studies have indicated that the Vertiflex procedure not only reduced pain for participants, but it also reduced opioid dosing.
Finally, the last step for stage 4 cervical spinal stenosis is surgery. Within this category of treatment there are a variety of options.
- Laminectomy: This removes the area of bone pressing on the nerve.
- Laminoplasty: Bone is removed and plates and screws are inserted to restore and maintain the height of the vertebral space.
- Foraminotomy: The foramen — the space where nerves exit the vertebrae — is enlarged to allow nerves to pass without compression.
Get Back To A Life Without Pain
It can be tough to go about your day when you are in pain. Cervical spinal stenosis can make even the simplest tasks challenging and uncomfortable.
You deserve to live a full life without pain.
At Arizona Pain, we understand the effect a chronic condition can have on you and your family. Our pain specialists can diagnose your cervical spinal stenosis and tailor a treatment plan that can help you get your life back. Get in touch to get started today.