Cervical Stenosis

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Cervical Stenosis

What is Cervical Stenosis?  

Cervical stenosis is the abnormal narrowing of the spinal canal in the neck. This narrowing can be due to a variety of causes including a traumatic cervical injury, inflammation, or a space-occupying lesion (e.g. Disk herniation, facet joint hypertrophy, thickening of ligaments, or bone spur formation).  Abnormal narrowing places pressure on the spinal cord &/or nerves resulting in pain and or weakness (Myelopathy). These symptoms can be temporary, constant, or even progressive depending on the cause and the extent of narrowing.  

Though ~80%of the population will report some neck pain during their lives, cervical spinal stenosis only occurs in ~5% of the population and increases in prevalence with age (~9% by age 70).  Stenosis can be central (Meaning that pressing directly on the spinal cord) or can occur in the peripheral joints of the spine and press on the nerve roots exiting the spine.

Anatomy:

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  • Bones and Joints: There are 33 vertebrae that make up your spine, 7 of them are in your neck. The vertebrae stack on top of one another to provide a solid protection for the spinal cord and the joints allow for movement. The vertebral body is the weight-bearing portion of the spine and makes up of the anterior (Front) part of your spinal canal. The posterior (Back) part of your spinal canal is made up of the neural arch that includes:  Pedicles, Laminae, facet joints, spinous, and transverse process
  • Ligaments and discs: Through the spine, there are many ligaments to help stabilize your spine and protect the delicate spinal cord. Between each vertebra is an intervertebral disc- these discs add space between each vertebra to reduce risk of compressing nerves and spinal cord. The major ligaments in the cervical spine are:Image result for spine ligaments

Anterior and posterior longitudinal ligaments – long ligaments that run the length of the vertebral column, covering the vertebral bodies and intervertebral discs.

Ligamentum flavum – connects the laminae of the adjacent vertebrae

Interspinous ligament – connects the spinous processes of the adjacent vertebrae.

Nuchal ligament – it is attached to the tips of the spinous processes from C1-C7. 

Transverse and Alar ligaments– it is attached to the top two cervical vertebrae to the head and keeps the lower vertebra from compressing the spinal cord. 

  • Nerves: 8 pairs of cervical nerves exit in the spine between the vertebral levels. The area that these nerves exit is called the transverse foramen, which is made up the top vertebra that is sitting on the bottom vertebra. These nerves control the muscles in your arms and handsNeck assessment and screening
  • Muscles: There are many muscles that are connected to the head and the neck. The major muscles that are typically involved and can be weak and or painful are: the Sub occipital muscles, scalene muscles (Anterior, middle, posterior), sternocleidomastoid, upper trapezius, levator scapula, and the deep cervical flexors.

How is Cervical Stenosis Diagnosed?

  • Patient’s Symptoms can be variable depending on the severity of stenosis, area that stenosis occurs, and the level that is primarily affected. Potential symptoms include: Pain in the neck, shoulder, arm, or hand, weakness or clumsiness in the hands, difficulty using arms and/or legs, difficulty walking, frequent falling, changes in bowel and bladder function (Incontinence)
    • Central cervical stenosis may require surgery to correct, particularly if the symptoms are quickly progressing and involve bowel and bladder changes
  • Examination: During the physical examination, strength and flexibility will be assessed in the neck and arms. Other typical areas that are looked at are the presence of the upper motor neuron signs to see if the brain or spinal cord are being affected- these signs are: increased muscle tone (Resistance to passive movement), clonus (extremity taps repeatedly with quick stretch), the return of integrated reflexes, and difficulty with balance with walking. The upper motor signs would be a sign of central cervical stenosis
    • Imaging & tests: MRI is typically the most accurate way to diagnose cervical stenosis with neural compression, but they may start with X-ray’s to check for any boney explanations for your symptoms. 
    • Other tests they may do are: CT scan with myelogram (To better see your spinal cord), or a somatosensory evoked potential (SSEP) – an electrical study to see how your brain and nerves are working.

How can Physical Therapy Help? 

No matter how long your neck pain or other symptoms have been going on, here at Kinetic we want to help you improve your pain and get back to normal.  After your initial evaluation, we personally develop a treatment plan to fit your individual needs. Though we cannot change any underlying boney changes in your spine, we can improve your strength and mobility in your neck. When our muscles and joints are not working the way they are intended to, our body creates poor movement patterns that perpetuate the pain cycle. When working with patients with cervical stenosis, we focus on those deep cervical muscles to keep your neck strong and stable. We also work directly on any other areas that have been impacted- flexibility, balance, or coordination.  We work hard to use all our resources to get you back on track so that you can get to where you want to go in life. 

For More Information about Cervical Stenosis:

American Physical Therapy Association

https://www.choosept.com/symptomsconditionsdetail/physical-therapy-guide-to-spinal-stenosis

Spine-health

https://www.spine-health.com/conditions/spinal-stenosis/cervical-stenosis-myelopathy