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115: CERVICAL SPINAL STENOSIS

Arie J. Van Duijn, EdD, MSc, PT, OCS; Eric Shamus, PhD, DPT, PT, CSCS

CONDITION/DISORDER SYNONYMS

  • Cervical spinal stenosis

  • Cervical central stenosis

  • Central stenosis

  • Lateral stenosis

ICD-9-CM CODES

  • 723.0 Spinal stenosis in cervical region

  • 724.0 Spinal stenosis other than cervical

ICD-10-CM CODES

  • M48.00 Spinal stenosis, site unspecified

  • M48.02 Spinal stenosis, cervical region

PREFERRED PRACTICE PATTERN

  • 4F: Impaired Joint Mobility, Motor Function, Muscle Performance, Range of Motion, and Reflex Integrity Associated with Spinal Disorders1

PATIENT PRESENTATION

A 72-year-old male presents with gradually increasing complaints of diffuse neck pain, cramping and pain in both the upper and lower extremities, and occasional loss of bladder control. These symptoms are aggravated with cervical extension and relieved with cervical flexion. A pronounced forward-head posture is noted, and there is a significant loss of active and passive cervical range of motion in all directions. Neurological examination revealed increased muscle tone bilaterally in the biceps brachii and gastrocnemius muscles with brisk deep tendon reflexes. A positive Babinski reflex was present bilaterally. MRI evaluation revealed narrowing of the central spinal canal in the lower cervical region, along with loss of disk height and significant osteophyte formation in this area.

FIGURE 115-1

Imaging studies in a patient with cervical spondylosis and chronic neck pain. (A) Radiograph showing collapsed disk space between C5 and C6 and a large posterior osteophyte at the inferior endplate of C6. (B) MRI showing collapsed disk spaces, a mild stenosis of the spinal canal, and effacement of the spinal cord by an osteophyte at C6. (From Skinner HB. Current Diagnosis & Treatment in Orthopedics. 4th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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KEY FEATURES

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 disks 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.

CLINICAL FINDINGS

SIGNS AND SYMPTOMS

  • Bilateral leg pain

  • Unilateral or bilateral upper limb pain and myelopathy with cervical ...

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