Causes of Cervical Spinal Stenosis

Acute injury, such as whiplash from a car accident, contact sports injury, or a fall, can cause nerve trauma and damage to the intervertebral discs, spinal ligaments, and bones and muscles in the neck. Short-term inflammation and pain may dissipate as the body heals, but there are often long-lasting effects from such trauma.

In one review patients who had suffered whiplash were found to have a 60% incidence of chronic cervical facet joint pain, with C2-C3 and C5-C6 the most frequently affected levels in the cervical spine (Barnsley, 1995). Manchikanti (2004) found that the facet joints were implicated as a cause of chronic neck pain in 54-67% of patients, making acute trauma a considerable factor in the aetiology of chronic neck pain.

Other, degenerative, conditions can be responsible for cervical spinal stenosis, including osteoarthritis (spondylitis), ankylosing spondylitis, scoliosis, spondylolisthesis, and degenerative disc disease. Rheumatoid arthritis may also cause alterations in the structures of the cervical spine, with subaxial subluxation, atlantoaxial instability, and basilar invagination possible causes of spinal stenosis in the neck. Such instability can result in pain at the base of the skull, through the neck and into the upper back. Radiculopathy extending through the shoulders, arms, hands, and fingers is also frequently experienced as the cervical spinal nerves are compressed and the spinal cord is impacted by stenosis. Pain maps can help a physician to isolate the likely origin of the nerve compression with different cervical nerves innervating particular parts of the upper limbs.

Accurate diagnosis of the problem nerves is paramount as the majority of failed back surgery syndrome sufferers have found little benefit from back surgery due to an initial misdiagnosis rather than the failure of the procedure itself. Selective nerve root blocks may be possible prior to surgery but are not always favoured by cervical spinal surgeons due to the complexity of the anatomy in the neck and the increased possibility of incurring a dural tear during such procedures.

Treatment Options –> Cervical Spinal Fusion

References

Barnsley, L., Lord, S.M., Wallis, B.J., Bogduk, N., (1995), The prevalence of chronic cervical zygapophysial joint pain after whiplash, Spine, Vol.20, No.1, pp.20-5; discussion 26.

Manchikanti, L., Boswell, M.V., Singh, V., Pampati, V., Damron, K.S., Beyer, C.D., (2004), Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, and lumbar regions, BMC Musculoskelet Disord, Vol.5, p.15.