Cervical Stenosis: Causes, Symptoms, Treatment and Cost

Narrowing of the cervical spinal canal is referred to as cervical stenosis. This narrowing can cause some neurological problems such as neck and arm pain, weakness in the arms and legs, altered sensation, and even paralysis.

Cervical stenosis is classified into two main types: central and foraminal.

• Central Cervical Stenosis: This occurs when the spinal canal narrows due to an overgrown ligament or bone spurs compressing nerve roots within the spinal cord itself. In extreme cases, central stenosis can cause problems with walking, use of hands, coordination and even breathing.
• Foraminal Cervical Stenosis: This occurs due to compression of a nerve root occurring outside of the actual spinal cord itself in an area known as the neural foramen (or opening). The most common causes are overgrown ligament tissue or bony growths from osteoarthritis compressing one or more nerve roots that exit from each level of your spine at these openings – also known as a ‘pinched’ nerve.

The normal wear and tear of age, which may result in a neck spinal canal narrowing, is often the root cause of cervical stenosis.
Other causes of cervical stenosis include trauma from an accident, degenerative joints, and disc diseases, such as arthritis, osteoporosis, and herniated discs, as well as congenital narrowing of the spinal canal.
Conditions such as Paget’s disease or bone tumors can also cause narrowing of the spine in the neck which leads to stenosis.

These are common symptoms of Cervical Stenosis:

• Neck and back pain, especially when bending the neck.
• Arms and legs that tingle, are numb or burn.
• weakness in the muscles and trouble walking.
• loss of coordination or balance.
• a lack of bowel or bladder control.

To prevent Cervical Stenosis, you should:

• Follow a healthy lifestyle, exercise daily, and maintain healthy body weight.
• Follow an ergonomic approach when participating in activities that require lifting or bending.
• Practice good posture by keeping the head in a neutral position and avoiding cradling the phone between the shoulder and ear for extended periods of time.
• Maintain correct sleeping postures to reduce strain on the spine.
• Avoid activities or sports that require excess flexing or hyperextension of the neck such as diving, wrestling or gymnastics.
• Use heat/cold therapy to relax painful muscles when needed.
• While doing tasks that require heavy lifting or neck-twisting motions, use a neck support brace.

Diagnosis of Cervical Stenosis often includes:

• Physical exam: A doctor may perform a physical exam to assess your symptoms, check your range of motion, feel for any lumps or tenderness, and look for signs of nerve compression.
• X-rays: X-rays may be used to assess the integrity and alignment of the cervical spine.
• CT (computed tomography) scan: During a CT scan, cross-sectional pictures of the cervical spine are captured using X-rays.It can help detect areas where there is a narrowing of the spinal canal.
• MRI (magnetic resonance imaging): An MRI can create detailed images that show tissue structure in more detail than X-ray or CT scans. It can help diagnose spinal stenosis by determining how much narrowing is occurring and how much it is affecting the nerves within the spinal canal.
• Nerve conduction studies (NCS): These tests measure electrical signals sent through nerve pathways in order to detect changes that could indicate nerve damage due to compression from spinal stenosis.
• Electromyography (EMG): EMG tests measure muscle activity in response to electrical stimulation in order to detect abnormalities or changes that could indicate nerve damage from a pinched nerve related to spinal stenosis.

Potential dangers associated with Cervical Stenosis:

• Pressure on the spinal cord: Spinal cord compression due to the narrowing of the cervical spine can lead to tingling, numbness, pain, difficulty walking, and incontinence.
• Spinal instability: Due to the weakening of the surrounding ligaments and tendons as they become stretched over time, spinal stability can be compromised.
• Cord impingement: Narrowing of the vertebral canal may cause nerves exiting the spinal cord to become pinched or impinged leading to nerve-related symptoms.
• Myelopathy: The decreased room in the vertebral canal caused by the condition can result in myelopathy, a neurological disorder caused by direct pressure on or damage to the spinal cord itself.

Here are some natural remedies useful for the treatment of Cervical Stenosis:

• Frequent yoga and pranayama practice may improve blood flow and lessen discomfort.
• Warm sesame or coconut oil may be applied to the region to reduce discomfort and inflammation.
• Use of medicinal herbs like ashwagandha, shilajit, ginger, turmeric, and garlic to lower joint pain and improve the flexibility of the cervical spine.
• Inhaling steam from freshly boiled water mixed with herbal oils like eucalyptus or lavender for relief from pain.
• Massaging the neck area with warm wooden massage tools for quick relief from muscular spasms and tension related to cervical stenosis.

Eating a healthy, balanced diet is key for managing symptoms of cervical stenosis. A variety of fruits, vegetables, whole grains, lean meats, and healthy fats should be included.

• Choose foods that are rich in calcium and vitamin D such as dairy products, fortified cereals, fish with edible bones (such as sardines and salmon), dark leafy greens like kale or spinach, and tofu made with calcium-fortified soymilk.
• Choose foods that are high in anti-inflammatory properties such as fatty fish (including salmon or tuna), olive oil, and avocados.
• Increase your water intake to prevent dehydration which can cause pain to worsen in the neck area.

The following foods should be avoided in Cervical Stenosis:

• Processed and Packaged Foods: Low in fiber and high in salt, sugar, fat, and calories are typical characteristics of highly processed meals. Examples include store-bought baked goods and snacks like chips, packaged ramen noodles, frozen dinners, and meal replacements.
• High-fat Food: Fried food is particularly difficult for people with cervical stenosis because they contain saturated fats that can cause inflammation in the spine. Examples include fried chicken, French fries, doughnuts, and desserts made with butter or oil.
• Alcohol: Alcohol can further irritate the spine due to its support of acidic urine which increases the irritation from salt deposits present inside the vertebrae joints which affects pain levels from cervical stenosis even further.
• Refined Grains: These processed carbohydrates in refined grains spike blood sugar levels quickly before crashing them down soon afterward. This causes an energy dip often accompanied by a spike in hunger levels. Refined grains include white bread, white rice, some breakfast cereals, crackers, pastries & other baked goods.

Treatment for Cervical Stenosis may include the following:

• Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) are typically prescribed to relieve pain, swelling, and inflammation associated with cervical stenosis.
• Physical Therapy: A physical therapist can help those suffering from cervical stenosis by teaching stretching and strengthening exercises as well as implementing hands-on treatments such as massage, trigger point therapy, and muscle tension release techniques.
• Cervical Collar: A soft cervical collar can be worn to provide support and restrict movement in order to reduce symptoms of cervical stenosis.
• Microdiscectomy: Removal of a herniated disc in the cervical spine, which creates pressure on nerve roots and the spinal cord. Anterior cervical discectomy and fusion (ACDF): Removal of the damaged or diseased disc from the cervical spine and fuses the vertebrae above and below it together to provide support.
• Laminectomy: Removes all or part of the lamina to widen the spinal canal, relieving pressure on nerve roots and/or the spinal cord. Artificial Disc Replacement: This involves replacing a damaged intervertebral disc with an artificial one to maintain motion in the vertebral column while relieving pain.
• Posterior Cervical Foraminotomy: Removal of part of the vertebrae to enlarge a small opening (foramen) in the spine, allowing nerves to exit without compression or irritation.

The best doctor to consult for cervical stenosis is an orthopedic surgeon, as these doctors specialize in conditions and treatments of the spine.
A neurologist may also be consulted if neurological symptoms such as numbness, tingling, or muscle weakness are present, as they specialize in treating disorders of the nervous system.

Commonly used medicines in the treatment of Cervical Stenosis are:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): These are medications like ibuprofen and naproxen that reduce inflammation and associated pain.
• Muscle Relaxants: Medications that work to protect against or reduce muscle spasms, such as cyclobenzaprine, carisoprodol, or methocarbamol.
• Corticosteroids: Man-made hormones used for their anti-inflammatory effects, such as prednisone and prednisolone.
• Anticonvulsants: These meds help control nerve pain caused by damaged nerves connected to the spine, such as gabapentin or pregabalin.
• Opioids: Typically used only when other treatments have not worked and pain is significant, this class includes drugs like oxycodone and morphine that act on the central nervous system to block pain signals from reaching the brain while also providing a calming effect on emotions and behavior.

Depending on how severe the issue is, recovering from cervical stenosis may take a certain length of time. It often takes a few weeks to several months for conservative therapies like medication and physical therapy to decrease pain and improve mobility.In more severe cases that may require surgery, recovery times can range from two to three months or longer.

The severity of the problem, as well as the technique of therapy, will affect how successfully cervical stenosis is managed.
Surgery may provide permanent relief in severe cases, whereas less invasive treatments such as physical therapy and medication may provide more temporary relief.

Commonly used medicines in the treatment of Cervical Stenosis are:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): These are medications like ibuprofen and naproxen that reduce inflammation and associated pain.
• Muscle Relaxants: Medications that work to protect against or reduce muscle spasms, such as cyclobenzaprine, carisoprodol, or methocarbamol.
• Corticosteroids: Man-made hormones used for their anti-inflammatory effects, such as prednisone and prednisolone.
• Anticonvulsants: These meds help control nerve pain caused by damaged nerves connected to the spine, such as gabapentin or pregabalin.
• Opioids: Typically used only when other treatments have not worked and pain is significant, this class includes drugs like oxycodone and morphine that act on the central nervous system to block pain signals from reaching the brain while also providing a calming effect on emotions and behavior.

The cost of treatment for cervical stenosis in India ranges from ₹4,000 to ₹10,000 depending on the severity of the condition. This cost usually includes diagnostic procedures such as X-rays, CT scans, and MRIs, if necessary. If surgical intervention is needed, additional expenses like hospitalization and anesthesia may be incurred which can add to the overall cost.

Common side effects caused by Cervical Stenosis treatments may include the following:

• Surgery for cervical stenosis can cause nerve injury, infection, and bleeding.
• Medication used to reduce inflammation and pain may cause nausea or dizziness.
• Steroid injections can lead to local tissue damage, nerve irritation or weakness in the injected areas.
• Physical therapy is usually well tolerated but may cause mild soreness at the treatment sites.