Ordinarily, you might not think too much about your spinal cord, since it’s protected by your spinal canal. But imagine what might happen if your spinal canal began to narrow around your spinal cord. As you might imagine, the smaller canal would put pressure on your spinal cord and the nerve roots.

If this happens in the area of your neck, it creates an often painful condition called cervical spinal stenosis. It can also damage your spinal cord and nerves and their functions, creating a condition called myelopathy. Let’s look at why the spine might narrow and how it can be treated.

In many cases of cervical stenosis with myelopathy, degeneration is often the cause. That is, you can blame age, genetics, and general wear and tear. In fact, according to Emory Healthcare, this condition occurs most commonly after age 50.

Research suggests you may experience ossification (or hardening) of some of the ligaments that surround the spinal cord as you age. These ligaments include the posterior longitudinal ligament and the ligamentum flavum.

As the ligaments begin to thicken and harden, they push into your spinal canal and crowd your spinal cord. The discs in your cervical spine may also shrink and harden, pressing up against your spinal cord.

Some people are also born with a naturally narrow spinal canal. This condition is called congenital spinal stenosis.

Other possible causes include:

  • injury to the neck, such as trauma or whiplash
  • rheumatoid arthritis in the neck
  • spinal infection
  • tumors

Some people who have cervical stenosis with myelopathy do not experience any symptoms at all. However, it’s also very possible that you will experience certain symptoms in your neck.

According to the North American Spine Society, these symptoms include:

  • limited range of motion
  • pain in the neck
  • pain that shoots down the spine from the neck
  • stiffness

And many people with this condition also experience symptoms that go beyond the neck area where their spinal cord is compressed.

For example, symptoms often affect your gait and balance. A key symptom of cervical stenosis with myelopathy for many people is clumsiness. When they try to walk, they walk with a clumsy gait. They may have trouble maintaining their balance when they stand and walk, too.

Other symptoms that you may experience with this condition include:

  • numbness and tingling in the arms and hands, which can make it difficult to handle objects easily
  • weakness in the arms and hands
  • sensory changes in the legs
  • urgent need to urinate
  • bowel or bladder incontinence

Of course, symptoms can vary. The North American Spine Society estimates that about half of all people with cervical stenosis with myelopathy experience pain in their neck and arms. And most have some type of arm dysfunction, too.

The North American Spine Society says your doctor will start out by taking a complete medical history. This will include any back and neck problems you’ve ever experienced. They will likely also ask about your family history, so it may be helpful to ask older family members if they have symptoms similar to yours.

A physical examination will follow, as your doctor will evaluate your reflexes and muscle strength. They’ll also test how well the nerves work in your arms, legs, bladder, and bowels. For example, your doctor might examine your upper extremities, evaluate your grip, and look for ways that you may be struggling to handle small objects.

Your doctor may also look for Lhermitte’s sign. This is a sensation like an electric shock going down your back and radiating out into your extremities. Your doctor may want to conduct some electrical tests, too, to see how well your spinal cord communicates with the nerves in your arms and legs.

A cervical spine X-ray may be appropriate for some people, too. Based on the results, your doctor may also order a cervical MRI. This imaging technique can allow your doctor to better understand what may be happening in your spine.

Depending on how severe your pain or dysfunction is, your doctor might suggest starting with a nonsurgical treatment first. But experts say that surgery is often necessary to prevent the condition from worsening and causing more damage.

Nonsurgical treatments

According to Emory Healthcare, pain management is a key aspect of nonsurgical treatment for cervical stenosis with myelopathy. So, your doctor might suggest starting with pain relievers, such as:

Other nonsurgical treatment options can include:

If your symptoms are progressing, nonsurgical treatments will only provide short-term relief, according to 2022 research, not “definitive treatment.” Your doctor will know for sure which treatment or combination of them will be right for you.

Surgical treatment options

A 2021 review suggests surgery is needed for some people to address pain and dysfunction. This is especially true if the condition is progressing and causing further neurological damage. The goal of these surgeries is to widen the canal space and relieve some of the compression on the spinal cord.

Your doctor will consider a number of factors before recommending a surgical approach, according to the University of Virginia School of Medicine. This includes whether to perform the surgery through the front of your neck, known as anterior surgery, or the back of your neck, known as posterior surgery.

Surgical options can include:

  • cervical laminoplasty
  • cervical spinal fusion surgery
  • cervical laminectomy and fusion
  • anterior cervical discectomy and fusion

Medicare or other insurance may cover some types of spinal surgery if it’s deemed medically necessary for treating cervical stenosis with myelopathy. And even then, the payments can vary.

If you have insurance, depending on your insurance company and coverage, you may have to get prior authorization before you actually undergo the surgery. That means your doctor will have to file a report to your insurance company with their recommendation for your treatment. This can often delay treatment while you wait to find out if your insurance company will authorize payment for it.

Your insurance company may or may not approve coverage of the surgery. Or, it may require that certain conditions be met. For example, the company may require documents to prove that you’ve tried other treatments without success. If you’re concerned about coverage, it’s best to speak with a representative from your insurance company who will have the exact details of your plan.

Sometimes, the symptoms of cervical stenosis with myelopathy happen gradually over time. But for some people, they may progress more rapidly. If your symptoms are progressing, you will likely need some type of surgery. An MRI may be able to shed some light on the severity of symptoms and the potential for recovery.

Research suggests that you already have a more advanced case if you are experiencing bowel or bladder dysfunction. This may indicate a poor outlook.

It can be a lot to grapple with, especially if you have a higher degree of dysfunction or symptoms that greatly alter your quality of life. Talk with your doctor if you’re struggling and need additional support to help you cope with your condition.

You might also search ClinicalTrials.gov for possible opportunities to receive cutting-edge care through a clinical trial. Be sure to discuss this with your doctor before applying to a clinical trial. This can help you avoid any possible adverse reaction with your current treatment.

Living with cervical stenosis and myelopathy

Finding a community that understands what you’re going through can be a wonderful boost to your mental health during treatments for cervical stenosis. Your doctor or physical therapist is a great place to start when you’re looking for local support groups, but there are also some online ones:

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If you develop pain in your neck and then start to notice motor control or balance problems, don’t wait. Contact your doctor right away. It could be any number of conditions, but if you have developed cervical myelopathy, it’s important to get a diagnosis as soon as possible.

A variety of treatments are available to treat cervical stenosis with myelopathy, ranging from physical therapy to surgery. While there is currently no cure for this condition, most people are able to find a treatment that can relieve their pain and other symptoms.