Cervical Spinal Stenosis

What is cervical spinal stenosis?

Cervical spinal stenosis (CSS) is narrowing of the spinal canal in your neck. This condition is also called cervical stenosis. Your spinal canal is an open pathway that holds your spinal cord. Your spinal cord contains your nerves and controls your ability to move. When your spinal canal narrows, it may put pressure on your spinal cord. This may cause neck pain and limited movement in your arms. Treatment may reduce your pain and improve your body's ability to function.

What causes cervical spinal stenosis?

CSS is a chronic (long-term) condition. It usually is caused by degenerative conditions in the discs of your cervical spine. This is when your discs break down over time. Discs are tough, spongy cushions between your vertebrae (bones) that help move your neck. You may acquire CSS as you age, or it may be congenital. This means you are born with the condition. It is more common in people older than 50 years of age, and it may develop after an injury. CSS also may be caused by the following:

• Musculoskeletal problems: These are problems that occur with the muscles or bones in your neck. The vertebrae in your spine may weaken and slip out of place. The ligaments in your neck may harden. Ligaments are tissues that connect your bones. Ask your caregiver for more information about musculoskeletal problems that may cause CSS.
  
  
• Neck mass: This can be a tumor (abnormal tissue lump) or an abscess (pus pocket).
  
  
• Trauma: This includes accidents or sports injuries. Trauma may damage your vertebrae and narrow your spinal canal.

What are the signs and symptoms of cervical spinal stenosis?

Your signs and symptoms may vary based on where the stenosis is found in your neck. You may have no signs or symptoms. If your spinal canal is very narrow, your signs and symptoms may be worse. You may have any of the following:

• Neck pain and headaches.
  
  
• Burning pain that shoots from your shoulder down your arm.
  
  
• Weakness, numbness (loss of feeling), or tingling in your arm or hand. These symptoms may spread to your legs if your CSS is severe.
  
  
• Trouble urinating or having a bowel movement (BM).
  
  
• Trouble with balance and walking. You also may have trouble holding your neck up or standing up straight.

How is cervical spinal stenosis diagnosed?

You may learn you have congenital CSS after an injury. Your caregiver will ask about your signs and symptoms and your medical history. He will ask you where you hurt and how bad your pain is. He may do a physical exam. This may include checking the feeling, strength, and movement of your arms and legs. You also may need the following:

• C-spine x-rays: You may need cervical spine (c-spine) x-rays to check for broken bones or other problems in your neck. Several pictures may be taken of the bones in your neck.
  
  
• Computerized tomography scan: This is also called a CT scan. A special x-ray machine uses a computer to take pictures of your neck and head. It may be used to look at bones, muscles, tissue, and blood vessels. You may be given dye before the pictures are taken. The dye is usually given in your IV. An IV is a small tube put into your vein to give you medicines or liquids. The dye may help your caregiver see the pictures better. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may be allergic to some dyes. Tell the caregiver if you are allergic to shellfish or have other allergies or medical conditions.
  
  
• Magnetic resonance imaging: This test is called an MRI. During the MRI, pictures are taken of your head and neck. These pictures may show problems with your tissues, spine, and spinal cord. You will need to lie still during an MRI. Never enter the MRI room with any metal objects. This can cause serious injury. Tell your caregiver if you have any metal implants in your body.
  
  
• Electromyography: This is also called an EMG. An EMG is done to test the function of your muscles and the nerves that control them. Electrodes (wires) are placed on the area of muscle being tested. Needles that enter your skin may be attached to the electrodes. The electrical activity of your muscles and nerves is measured by a machine attached to the electrodes. Your muscles are tested at rest and with activity.

What medicines may be used to treat cervical spinal stenosis?

• Nonsteroidal anti-inflammatory medicine: This family of medicine is also called NSAIDs. NSAIDs may help decrease pain and swelling. This medicine can be bought with or without a doctor's order. NSAIDs can cause stomach bleeding or kidney problems in certain people. Always read the medicine label and follow the directions on it before using this medicine.
  
  
• Acetaminophen: This medicine is used to decrease pain. Taking too much of it can hurt your liver. Read labels so that you know the active ingredients in each medicine that you take. Talk to your caregiver before taking more than one medicine that contains acetaminophen. Ask your caregiver before taking over-the-counter (non-prescription) medicine if you are also taking pain medicine prescribed (ordered) for you.
  
  
• Opioids: This is strong medicine to decrease severe (very bad) pain. Opioids are also called narcotic pain medicines. Take this medicine exactly as directed by your caregiver.
  
  
• Muscle relaxers: This medicine helps relax your muscles. It is also given to decrease pain and muscle spasms.

What treatments may be needed for cervical spinal stenosis?

What treatment you have will depend on your signs and symptoms and how bad they are. Ask your caregiver for more information about these and other treatments for CSS:

• Therapy:
  
  
  • Physical therapy: You may need to see a physical therapist to teach you special exercises. These exercises help improve movement and decrease pain. Physical therapy can also help improve strength and decrease your risk for loss of function.
    
    
  • Occupational therapy: Occupational therapy (OT) uses work, self-care, and other normal daily activities to help you function better in your daily life. OT helps you develop skills to improve your ability to bathe, dress, cook, eat, and drive. You may learn to use special tools to help you with your daily activities. You may also learn new ways to keep your home or workplace safe.
  
  
• Steroid injections: This medicine is given as a shot into your neck to decrease pain and swelling.
  
  
• Nerve block: A nerve block is a shot of medicine that makes you lose feeling in an area of your body. You may need a nerve block if your pain is not going away, or is getting worse. A nerve block may also be used to make you lose feeling in an area before a procedure is done.
  
  
• Radiofrequency: This treatment uses electrodes (wires) to send signals to different parts of your body. These electrodes send electrical heat signals to your nerves. The heat of radiofrequency helps to ease your pain.
  
  
• Spinal cord stimulation: This treatment is also called SCS. With SCS, a small device is placed near your spine during surgery. The device sends electrical pulses to a certain area of the spinal cord. SCS may help relieve your pain and help you function better.
  
  
• Surgery: You may need surgery to widen your spinal canal or to decrease pressure on your spinal cord. Surgery also may be done to fix damaged or injured vertebrae in your neck.

What alternative treatments may be suggested for cervical spinal stenosis?

Your caregiver may suggest other forms of treatment to help with your condition. These may include the following:

• Acupuncture: Acupuncture is a treatment based on a belief that fluids flow through channels in our bodies. Caregivers insert very thin needles just under your skin. This is believed to open the channels, allowing fluids to flow better. This treatment may decrease pain and improve healing. Always see a caregiver for acupuncture. Do not try to give this treatment to yourself.
  
  
• Biofeedback: This is a special way to control how your body reacts to such things as stress or pain.
  
  
• Massage: Light massages, such as back rubs, may help decrease your pain. Ask your caregiver for more information about massage therapy and what type of massage is right for your condition.
  
  
• Relaxation therapy: Stress may cause pain, lead to illness, and slow healing. Relaxation therapy teaches you how to feel less physical and emotional stress. Deep breathing, muscle relaxation, and music are some forms of relaxation therapy.

What are the risks of cervical spinal stenosis?

• Certain medicines used to treat CSS may make you feel tired or dizzy. They may cause you to have trouble walking straight. Opioid pain medicines may be addicting (hard to stop taking when you don't need them). Opioids also may cause constipation (hard, dry BMs). In rare cases, steroid injections (shots) may cause you to have a headache. Steroid injections also may damage your spinal cord. This may cause worse weakness, shooting pain, or muscle spasms (uncontrolled movements) in your arms or legs.
  
  
• Surgery on your spine may cause neck pain. You also may have a hard time swallowing. Your nerves and spinal cord may become damaged, and you may lose some ability to move. Your surgery may not open your spinal canal fully. Surgery may not relieve all the pressure on your spinal cord. In rare cases, surgery may lead to death.
  
  
• Without treatment, you may have worsening signs and symptoms, such as burning neck pain, numbness, and weakness. It may be hard for you to do your normal daily activities. These may include bathing or dressing yourself. The pain may make it hard for you to sleep, or it may change your mood. You also may have trouble working or doing chores, such as lifting or carrying things. Cervical myelopathy may develop over time. This is when your spinal canal is pinched causing the nerve cells to be damaged. Without treatment, you may not be able to control when you urinate or have a BM. In rare cases, you may become paralyzed (unable to move body parts).

How can I help manage my cervical spinal stenosis?

• Eat a healthy diet. Eat a variety of healthy foods from all the food groups every day. Include whole-grain bread, cereal, rice, and pasta. Eat a variety of fruits and vegetables, including legumes (dry beans) and dark green and orange vegetables. Include dairy products, such as low-fat milk, yogurt, and cheese. Choose protein sources, such as lean meat and poultry (chicken), fish, beans, eggs, and nuts. Ask your caregiver how many servings of fats, oils, and sweets you may have each day and if you need to be on a special diet.
  
  
• Exercise as suggested by your caregiver. Exercise may help keep your condition from getting worse. It also strengthens the heart, lowers blood pressure, and helps your health. Safe exercise includes walking and using a stationary (not moving) bicycle. It is best to start exercising slowly and to do more as you get stronger. Ask your caregiver about these and other safe ways to exercise.
  
  
• Keep all follow-up visits with your caregiver. Ask your caregiver when to return for a follow-up visit. Make a list of questions to ask your caregiver at your visits. It may take time for your treatment to start working. Keep track of your pain, including where it hurts, how badly it hurts, and how often it hurts.
  
  
• Use ice or heat as directed. Ice or heat packs on your neck may help decrease your pain. Ask your caregiver for instructions about how to use ice and heat.
  
  
• Avoid certain activities. Ask your caregiver about these and other activities to avoid:
  
  
  • Some activities may worsen your condition. Avoid riding motorcycles or horses; climbing ladders; or playing contact sports, such as football.
    
    
  • Avoid bending your neck back too far, such as when you work on a computer, swim, or stretch. Adjust your computer monitor height. You also may request a headset if you talk on the phone a lot.

Where can I find more information?

Contact the following:

• American Chronic Pain Association
  PO Box 850
  Rocklin , CA 95677
  Phone: 1- 800 - 533-3231
  Web Address: http://www.theacpa.org
  

• National Spinal Cord Injury Association
  1 Church Street, Suite 600
  Rockville , MD 20850
  Phone: 1- 800 - 962-9629
  Web Address: www.spinalcord.org
  

• National Institute of Neurological Disorders and Stroke
  P.O. Box 5801
  Bethesda , MD 20824
  Phone: 1- 301 - 496-5751
  Phone: 1- 800 - 352-9424
  Web Address: http://www.ninds.nih.gov
  

When should I call my caregiver?

Call your caregiver if:

• Your pain does not get better or gets worse, even after taking medicines.
  
  
• You have questions or concerns about your condition, treatment, or care.

When should I seek immediate help?

Seek care immediately or call 911 if:

• You fall, and your pain and symptoms worsen.
  
  
• You have new or increased trouble walking.
  
  
• You have new or increased trouble going to the bathroom. You also may not be able to control when you urinate.
  
  
• You have more numbness, pain, tingling, or weakness than before.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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