Cervical Spinal Stenosis

Aka: Cervical Spinal Stenosis

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II. Findings: Symptoms and Signs

  1. See Cervical Myelopathy
  2. Neuropraxia with or without Transient Quadriplegia
    1. Mild: Motor changes (i.e. Muscle Weakness)
    2. Severe: Complete paralysis
  3. Sensory changes or Paresthesias into extremities
    1. Burning pain
    2. Numbness
    3. Tingling
    4. Loss of Sensation
  4. Neck Pain usually absent
  5. Complete recovery in most cases
    1. Early: 10-15 minutes
    2. Delayed: 36 hours

III. Causes

  1. Narrowing of cervical spinal canal
  2. Associated other predisposing factors (degenerative changes)
    1. Congenital cervical fusions
    2. Ligamentous instability
    3. Intervertebral disc disease

IV. Imaging

  1. See Cervical Myelopathy
  2. C-Spine MRI (preferred)
    1. Asymptomatic cervical stenosis with cord compression is a common incidental finding on imaging
  3. C-Spine XRay (Inaccurate)
    1. Spinal canal diameter (varies with magnification)
      1. Normal >15 mm
      2. Absolute Stenosis <10 mm
    2. Torg ratio
      1. Stenosis: < 0.8
      2. High sensitivity but poor Specificity

V. Management

  1. See Cervical Myelopathy

VI. Management: Return to competition

  1. Contraindications to participation
    1. Disc Herniation
    2. Vertebral Fracture or dislocation
    3. Significant Congenital Anomaly
  2. Guidelines after Transient Quadriplegia
    1. Contact Sport participation indications
      1. Symptom-free
      2. No Cervical Spinal Stenosis by C-Spine MRI
      3. Patient accepts risk of future Quadriplegia
    2. Contact Sport participation contraindications
      1. True Cervical Spinal Stenosis by MRI
      2. Consider minimal to no Contact Sports
        1. See Sports Contact Levels

VII. References

  1. Cantu (2000) Semin Neurol 20(2):173-8 [PubMed]
  2. Cantu (1998) Clin Sports Med 17(1):121-6 [PubMed]

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