If you have been recently diagnosed with cervical spinestenosis, you may be wondering if there is any option besidesmedication or surgery.
Cervical stenosis is a narrowing of the spinal canal in thecervical spine. The most common reasons are attributed toosteoarthritis, spondylosis, and degenerative disc disease. Discbulges especially have the potential to indent or cause mechanicalpressure on the spinal cord or the nerves that exit the spine fromthe neck into the hands (e.g., carpal tunnel syndrome).
Many of the most common symptoms associated with cervicalstenosis include neck pain, muscle tightness, and weakness,numbness, or tingling into the hands or fingers. Signs of cervicalstenosis can be seen with routine x-rays but are usually diagnosedwith CT or MRI scans.
The conventional medical approach for cervical stenosis issurgery. And it actually makes sense!
If there is a pebble in your shoe rubbing against your foot,take the pebble out! So if there is a bone or disc in your neckcausing compression of your spinal cord or nerves, get it out!
So when things get completely stuffed in the neck, surgery mayactually be the best option. However, many of the bestneurosurgeons agree that surgery should be the last option … andonly if all more conservative approaches haven’t been able tohelp.
Some of the natural approaches to help people with cervicalstenosis include massage therapy, physiotherapy, chiropractic, andosteopathy.
For many people diagnosed with cervical stenosis, thesetherapies are actually able to help so that surgery can be avoided.For other people, they don’t quite seem to work, in which casesurgery is necessary.
Does surgery always work for cervicalstenosis?
Alas, there is still a group of people who, even aftersuccessful surgery, still experience the same symptoms that theydid before.
They still have numbness, tingling, weakness, and pain in theirhands, shoulders, and neck.
One possibility may be that the stenosis caused nerve damagethat will take a long time to heal.
However, there may be another possibility that there is anotherhidden point causing the cervical stenosis: one that the surgerydid not actually fix.
Again, there is definitely a time and place when surgery forcanal stenosis is necessary.
Nevertheless, before you go ahead with surgery - or if you havehad surgery but still experience the same symptoms - I want to showyou how there could be a mechanical problem in the upper part ofyour neck that needs attention too.
Cervical Stenosis is like pulling on a piece ofstring
A new study has identified that cervical stenosis doesnot only have a local effect on the spinal cord but that itactually creates mechanical stretch and tension all the way throughthe neck.
Think of your spinal cord like a piece of string attached to aballoon (your brain). The string is anchored into the base of yourskull, the top three vertebrae in your neck (C1, C2, and C3), andyour tailbone (sacrum) by a series of ligaments known as myoduralbridges.
So if you have something like a bulging disc in your neckcausing canal stenosis, it can cause the string to stretch. Andguess where the points of tension will be?
The tension in the string will travel all the way up to the topand down to the bottom.
This is one of the reasons why so many people with symptomsassociated with canal stenosis also experience pain and otherproblems in other areas of their body:
- Headaches or migraines
- Sciatica or low back pain
- Neuralgia or fibromyalgia
This is true not only for classic types of cervical stenosiswith disc bulges but also the less-widely considered example of amechanical problem with the alignment of your upper neck that we’regoing to consider next.
Upper Cervical Alignment - A Hidden Cause of CanalStenosis?
The top vertebra in your neck is known as the atlas or C1. Itsfunction is to support the weight of your skull, protect yourbrainstem, and allow your head to nod up-and-down and rotate sideto side.
Approximately 50% of your total neck movement actually comesfrom this one area just above and below your atlas.
The reason that the atlas is able to move so much isthat it is the only vertebra in your spine that doesnot have an intervertebral disc that locks and limits itmotion.
The atlas is capable of movements in 360o planes beneathyour skull.
The opening at the base of your skull where your spinal cordextends from your brain is called the foramen magnum. Normally, theforamen magnum is directly in line with the opening through thering of the atlas.
Your atlas actually represents the very top of the cervicalspinal canal.
Now, I want you to imagine what would happen to that openingbetween the foramen magnum and your spinal canal if your atlas wasto shift off center and get stuck in an abnormal position. Ineffect, this would cause narrowing of the space right at the verytop of your spinal cord!
In other words, a misalignment that causes the atlas to shiftfrom its neutral position beneath the foramen magnum can be apotential source of canal stenosis.
Here’s the thing: there’s no disc up there! And especially ifsymptoms are in the hands, when cervical stenosis specialists maylook at MRI images, they are focussing on the lower part of yourcervical spine where all the discs and damage are.
… But what they may not realise is that there can still beanother point of stenosis up at the very top that you can’t quitesee unless you are paying very close attention to the alignmentbetween the skull and the C1 vertebrae.
To add insult to injury, many brain MRIs actually don’t go allthe way down to C1 … and many cervical MRIs don’t go all the way upeither! As a result, many of these potential points ofcervical stenosis are missed!
This may well be why some cases of known cervical stenosis donot respond to conventional treatment, whether conservatively orwith surgery.
It is because there is more than one point of stenosis …and the second one is just not as obvious.
Atlas Treatment and Cervical Stenosis
Because the atlas is at the very top of the spinal cord, if themechanical tension is transmitted all the way down the string, itmay be possible for a C1 misalignment to produce symptoms anywherein the body.
It is why there is an entire division of healthcare known asBlair Upper Cervical Care that focuses on the alignment of theatlas and the upper neck in neuromuscular disorders includingcervical stenosis.
Blair Upper Cervical care is a branch of chiropractic developednot in the USA that does not use any twisting, cracking or spinalmanipulation.
Its foundational premise is that every human being is builtdifferently on both the outside and inside. By using a unique formof analysis involving physical, neurological, and also advancedimaging studies, a Blair upper cervical chiropractor is able todetermine the exact location, direction, and degree of misalignmentof your atlas and in your neck.
When that is known, a treatment plan may be recommended thatdoes not involve any neck cracking. The entire process is designedto be custom-tailored for the individual, and thus using only as alight force as possible to help the body heal without drugs orsurgery.
As we’ve previously alluded, there can still be significantissues elsewhere in the neck or other parts of the spine thatultimately do require surgery for cervical stenosis.
However, if a misalignment involving the atlas is contributingto the problem in any way, it may well be an additional importantpiece of the puzzle that may be able to help people experience thebest possible outcomes.
Cervical Stenosis and Brisbane AtlasChiropractor
Dr. Jeffrey Hannah is the principal Blair upper cervicalchiropractor of Atlas Health located in North Lakes (northBrisbane).
Our mission is to help people dealing with chronic healthchallenges including cervical stenosis to find long-term solutionsso that they can enjoy the quality of life that they desire most.Dr. Hannah is an advanced certified instructor in the Blairtechnique and is an international lecturer, author, and recognisedleader in the field of upper cervical specific chiropracticcare.
If you would like more information, we would like to offer acomplementary 15-minute phone consultation where you can speakdirectly with Dr. Hannah to discuss your particular condition andask any questions you might have about cervical stenosis so thatyou can decide if care may be right for you.
Simply click the Contact Us link on this page, or phone usdirect at 07 3188 9329 to arrange an appointment.
We hope this article has been informative and valuable, and thatwe may be able to assist you.
Atlas Health Australia - “Hope, healing, and wellbeingfrom above-down, inside-out.”
Dennis AK, Oakley PA, Weiner MT, etal. Alleviation of neck pain by the non-surgicalrehabilitation of a pathologic cervical kyphosis to a normallordosis: a CBP® case report. J Phys Ther Sci. 2018Apr;30(4):654-657. doi: 10.1589/jpts.30.654. Epub 2018 Apr20. https://www.ncbi.nlm.nih.gov/pubmed/29706725
Fortner MO, Oakley PA, Harrison DE. Cervicalextension traction as part of a multimodal rehabilitation programrelieves whiplash-associated disorders in a patient having failedprevious chiropractic treatment: a CBP® case report.J Phys Ther Sci. 2018 Feb;30(2):266-270. doi:10.1589/jpts.30.266. Epub 2018 Feb 20.
Kessinger RC, Boneva DV. Case Study: Acceleration/DecelerationInjury with Angular Kyphosis. J Manipulative Physiol Ther, 2000;23(4):279-87.
McAlpine JE. Subluxation Induced Cervical Myelopathy: A PilotStudy. Chiropr Res J, 1991; 2(1):7-22.
Moustafa IM, Diab AAM, HegazyFA, Harrison DE. Does rehabilitation of cervical lordosisinfluence sagittal cervical spine flexion-extension kinematics incervical spondylotic radiculopathy subjects? J Back MusculoskeletRehabil. 2017;30(4):937-941. doi: 10.3233/BMR-150464.
Murphy DR, Hurwitz EL, Gregory AA. Manipulation in thepresence of cervical cord compression: a case series. JManipulative Physiol Ther. 2006Mar-Apr;29(3):236-44. https://www.ncbi.nlm.nih.gov/pubmed/16584950
Vallejo R, Kramer J, Benyamin R. Neuromodulation ofthe cervical spinal cord in the treatment ofchronic intractable neck and upper extremity pain: a caseseries and review of the literature. Pain Physician. 2007Mar;10(2):305-11. https://www.ncbi.nlm.nih.gov/pubmed/17387353
Wickstrom BM, Oakley PA, Harrison DE.Non-surgical relief of cervical radiculopathy through reduction offorwarding head posture and restoration of cervical lordosis: acase report. J Phys Ther Sci. 2017 Aug;29(8):1472-1474. doi:10.1589/jpts.29.1472. Epub 2017 Aug 10.
Wolf K, Reisert M, Beltrán SF, Klingler JH, Hubbe U, Krafft AJ,Egger K, Hohenhaus M. Focal cervical spinal stenosis causesmechanical strain on the entire cervical spinal cord tissue - Aprospective controlled, matched-pair analysis based onphase-contrast MRI. Neuroimage Clin. 2021 Feb 1;30:102580. doi:10.1016/j.nicl.2021.102580. Epub ahead of print. PMID:33578322. https://pubmed.ncbi.nlm.nih.gov/33578322/