Stenosis, cervical spine

• Cervical spinal stenosis
• Cervical central stenosis
• Central stenosis
• Lateral stenosis

• 723.0 Spinal stenosis in cervical region
• 724.0Spinal stenosis other than cervical

• M48.00 Spinal stenosis, site unspecified
• M48.02 Spinal Stenosis, cervical region

• Pattern 4F: Impaired Joint Mobility, Motor Function, Muscle Performance, Range of Motion, and Reflex Integrity Associated With Spinal Disorders

Description

• Common, degenerative spinal condition
• Associated with narrowing of the spinal canal (central stenosis) or foraminal canals (lateral stenosis)
• Caused by degenerative changes in intervertebral discs and facet joints
• Can result in spinal cord compression or nerve root compression

Essentials of Diagnosis

• Causes neurogenic claudication, with pain, cramping, and paresthesias in the upper extremity and lower extremity aggravated by cervical extension, relieved by cervical flexion
• Diagnosis made by clinical examination
• Differentiation between vascular and neurologic claudication
• Reproduction of symptoms in specific postures and activities

General Considerations

• Cervical spinal stenosis can result in spinal cord compression and resulting upper motor neuron signs
• Cervical central stenosis can give both upper and lower extremity symptoms

Demographics

• Prevalence increases with age
• Primarily occurs after 65 years of age

Signs and Symptoms

• Bilateral leg pain
• Unilateral or bilateral upper limb pain and myelopathy with cervical stenosis
• Pain worse with walking, relieved by sitting
• Can be with or without neck pain
• Altered sensation, motor control, and reflexes in the distribution of the involved nerve roots

Functional Implications

• Difficulty with walking long distances
• Difficulty with standing activities
• Possible bowel or bladder dysfunction with cervical stenosis
• Difficulty looking up
• Difficulty reaching overhead, painting overhead

Possible Contributing Causes

• Postural changes
• Weakness of core musculature

Differential Diagnosis

• Vascular insufficiency
• Peripheral nerve impairment
• Thoracic outlet syndrome
• Osteoarthritis
• Spinal tumor
• Peripheral neuropathy
• Degenerative disk disease

Imaging

• MRI helps to visualize compressed or inflamed nerve root in diagnosis
• X-ray/plain-film radiograph helpful if osteophyte located in intervertebral foramen
• CT scan to show herniation compressing the spinal canal/nerves

Diagnostic Procedures

• Electrodiagnostic/nerve conduction testing can help determine a specific impaired nerve function
• Doppler ultrasound to examine vascular function

• Physical examination
  • Two-stage treadmill test
  • ABI to screen for PAD
  • Quadrant test
  • Slump test
  • Upper limb nerve tension test
  • Deep tendon reflexes
  • Upper motor neuron testing, including tone, pathological reflexes
  • Upper/lower limb sensation testing
  • Passive physiological intervertebral mobility testing (PPIVM)
  • Postural examination
  • Muscle length testing, including pectoralis major, hamstrings, hip flexors, calf muscles

• To hospital for imaging
• To physician if surgical consult if myelopathy suspected
  • Fusion
  • Decompression
  • Laminectomy
• To hospital for imaging and medical consult if disease ...