Cervical spine stenosis is narrowing of the central spinal canal or neural foramina due to changes in bone or soft tissue. Stenotic compression may involve one nerve root, multiple nerve roots or most significantly, the spinal cord (myelopathy). Cervical spine stenosis is present in almost 5% of the adult population (1). The condition shows age-related progression, affecting nearly 7 percent of those over 50, and 9 percent of those over 70 (1).
Stenosis may develop from multiple factors, and it is often a combination of those factors that grow to reach a critical level of compression. Stenosis may be "congenital" or may be "acquired". The most common cause of stenosis is degenerative changes (2). In the normal aging process of the spine, the discs thin and spreads circumferentially. This places extra load on the many joints surrounding the discs. This generates pain and decreased range of motion, which is then followed by degeneration. Osteophytes ("bone spurs") can develop on the around the joints due to the increased stress (Wolff's law).
What are the symptoms of cervical spinal stenosis?
The natural history of stenosis is typically a slow, steady progression, although some patients' symptoms remain stable or even improve over time (5,12,27). Symptoms correspond to the progression degeneration and advance from local arthritic pain to radicular pain. Initially, neck pain and headaches are common. Symptoms may refer into the shoulder, arm, and upper back. Nerve root compression can cause radicular complaints of pain, pins and needles, tingling, or weakness in the shoulders, arms, or hands. Eventually, progressive cord compression causes loss of fine motor skills of the hand (perceived as clumsiness), leg pain, paresthesia, numbness, weakness, gait and balance disturbances, difficulty walking, and possible loss of bowel or bladder control. Patients who have progressed to myelopathy report relatively little to no neck pain.
Are x-rays or other imaging needed for cervical spinal stenosis?
Radiographic imaging is essential to define stenosis (28). The normal sagittal diameter of the spinal canal, as measured on lateral radiographs, is approximately 17-18 mm (10). “Relative stenosis” is defined as having a canal between 10-13 mm, with “absolute stenosis” in canals measuring less than 10 mm. Flexion/extension views that demonstrate greater than 3 mm of translation suggest instability as a possible contributor. MRI is the preferred method of diagnostic imaging for stenosis, as it can see both hard and soft causes of encroachment (12,28).
What are the best treatment options for cervical spinal stenosis?
The need for neurosurgical consultation progresses proportionately with the course of stenosis. Any signs or symptoms of central cord compression warrant immediate neurosurgical evaluation. In the absence of myelopathy or significant nerve root involvement, a trial of conservative care may be prudent (16,24). Conservative treatments are directed at relieving symptoms and preserving cervical spine mobility and strength.
While patients with biomechanical joint dysfunction from early spondylosis may benefit tremendously from spinal manipulation, the presence of myelopathy is an absolute contraindication to HVLA manipulation (17). Low-force techniques, including Grade 1-4 mobilization, activator, and cervical flexion distraction may be more appropriate for patients with more than moderate degenerative change.
Nerve mobilization technique and cervical traction have been advocated in the treatment of stenosis patients (18,19) Nerve mobilization techniques may help reduce nerve adherence, facilitate nerve gliding, decrease mechanosensitivity, reduce intraneural swelling and improve axoplasmic flow (20,21). Cervical traction may result in pain inhibition, separation of vertebral bodies, neuroforaminal widening, and decreased intradiscal pressure (18,19, 22,23,31). Traction has shown to provide relief for cervical radicular complaints (32). Patients can be sent home with nerve mobilization exercises and instructed on the use of home traction (15-20 minutes, 2-3 times per day with a weight of 10 pounds slowly increasing toward 20).
Modalities including acupuncture, ice, heat, massage, ultrasound, and electrical stimulation may provide symptomatic relief. Soft tissue manipulation, IASTM, and contract/relax stretching may be used to address areas of myofascial involvement in the cervical and shoulder girdle musculature. Exercises may be implemented prudently to improve neck mobility and muscular strength as well as extremity coordination, balance, and aerobic capacity. Cervical strengthening exercises may assist with intersegmental stability.
Medical co-management may include NSAIDs and muscle relaxants. Epidural steroid injections may provide some benefit for radicular complaints, but their use for central canal stenosis is controversial. Neurosurgical consultation is appropriate for any patient with signs of stenosis and is a necessity in cases of myelopathy. Based upon the status and progression of the disease, a careful “wait and watch” approach to surgery may be appropriate. Surgical intervention is directed at relieving pressure on the spinal cord and nerve roots, often through decompressive laminectomy coupled with a spinal fusion (24,25).
At Creekside Chiropractic & Performance Center, we are highly trained to treat cervical spinal stenosis with conservative care, and we work together with orthopedists to ensure the best standard of care is given. We are the only inter-disciplinary clinic in Sheboygan county that provides chiropractic, myofascial release, ART (Active Release Technique), massage therapy, acupuncture, physiotherapy, rehabilitative exercise, nutritional counseling, personal training, and golf performance training under one roof. Utilizing these different services, we can help patients and clients reach the best outcomes and the best versions of themselves. Voted Best Chiropractor in Sheboygan by the Sheboygan Press.
Evidence Based-Patient Centered-Outcome Focused
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