What is it?

The cervical spine is the part of the spine that makes up the neck. Cervical stenosis is when the central spinal canal (the space where the spinal cord travels down the spine) becomes narrowed at the level of the neck. This narrowing can be congenital (meaning one was born with the narrowing) or by degenerative (arthritic) changes in the cervical spine, which is known as cervical spondylosis. The degenerative changes seen are osteophytes (bone spurs), disc herniation, and enlargement of certain stabilizing ligaments found within the spinal canal.

The narrowing can impinge/pinch important neurologic structures and cause injuries such as myelopathy (injury to the spinal cord) and radiculopathy (injury to the spinal nerves) if severe enough.

Symptoms

Common symptoms of cervical spondylosis are limited neck motion and pain. Pain is usually worse with upright activity and can be associated with neck muscle spasms. If cervical spondylosis is coupled with stenosis that is causing impingement of nerves, one may have pain, numbness, tingling, and weakness (known as radicular symptoms) in the arms and hands. If the narrowing is pinching the spinal cord, then one may not only have radicular symptoms in the arms or hands, but may also show these symptoms in the legs and feet along with impaired dexterity (incoordination of the hands) and gait dysfunction (impaired coordination when walking). If the myelopathy is severe enough, one may have urinary dysfunction, such as urinary incontinence, as well.

Sports Medicine Evaluation & Treatment

A sports medicine evaluation will include taking a history, performing a physical exam, and likely obtaining imaging of the cervical spine. Physical examination should include palpation of the posterior cervical spine, range of motion testing of the cervical spine, a neurological exam (including assessment of muscle strength, skin sensation, reflexes, coordination, and gait), and some provocative maneuvers, such as Spurling maneuver, to try to reproduce radicular symptoms. Diagnostic imaging may include cervical spine radiographs (x-rays) to evaluate the bones and joints, and magnetic resonance imaging (MRI) to obtain more details on the nerves, muscles, and discs of the neck. An electromyogram and nerve conduction study (EMG/NCS), which will give information on the health of the nerves and their connections to muscles, may also be performed to help confirm a radiculopathy.

Treatment may include rest from activities that cause pain and symptoms, nonsteroidal anti-inflammatories (NSAIDs), and physical therapy to work on cervical spine range of motion and strengthening. Opioids or narcotic medications should be avoided. If symptoms do not respond to these treatments, or if there is stenosis causing worsening nerve injury, then surgery may be needed to fuse and decompress the problematic areas of the cervical spine and take pressure off of the nerves.

Injury Prevention

A cervical spine flexibility and strengthening program, directed by a certified athletic trainer or physical therapist, is important to address any areas of weakness that can lead to a cervical spine injury. Also, practicing proper tackling technique and use of appropriate protective equipment will help keep athletes safe who take part in contact/collision sports.

Return to Play

Return to play for athletes with known cervical stenosis is controversial. Cervical stenosis increases the risk of permanent nerve damage if one suffers cervical spine trauma. An athlete with cervical stenosis without any symptoms or history of a cervical spine injury is allowed to play contact/collision sports, however, they must understand the increased risk of serious cervical spine injury (including paralysis and death) with continued participation. If an athlete with cervical stenosis has symptoms and/or has sustained a traumatic cervical spine injury, then return to play in contact/collision sports generally is not allowed and consideration of a change in sport is often necessary.

AMSSM Member Authors
Michael Stiller, MD

References
Altman, Daniel T., and Mark C. Hubbard. “Section 8 Spine/Cervical Spondylosis.” Essentials of Musculoskeletal Care 5, by April D. Armstrong and Mark C. Hubbard, American Academy of Orthopaedic Surgeons, 2016, pp. 961–964.
Cheng, Abby, and Monica E. Rho. “Chapter 18/Cervical Spine Injuries and Conditions.” Sports Medicine: Study Guide and Review for Boards, by Mark A. Harrast and Jonathan T. Finnoff, 2nd ed., Demos Medical Publishing, 2017, pp. 212–213.