Congenital Stenosis of the Cervical Spinal Canal

Congenital stenosis of the cervical spinal canal is the narrowing of the spinal canal in the neck (Fig. 1). This condition, which exists at birth but is not hereditary, puts the affected person at increased risk of injuring the spinal cord.

The spinal canal lies within the spine and encases the spinal cord. The vertebral body (back bone) forms the front and the lamina (bony covering) forms the back of this canal. The spinal cord travels from the brain through the canal to the lower back, giving feeling and movement to the entire body.

Am I at risk for injury?
Spinal cord injury can occur when the neck is forced to bend too far forward or backward or is com-pressed through a blow to the top of the head. With these motions, the spinal cord can be pinched within the narrow canal.

Athletes who have cervical spinal stenosis and participate in contact sports (e.g., football, martial arts, basketball) are at risk for serious nerve injuries due to pinching within the spinal canal. Symptoms include burning pain, tingling, or numbness in both arms and possibly both legs. The symptoms usually subside within a few minutes. Occasionally, they last one or two days. Bruising of the cervical spinal cord can result in transient quadriplegia, producing temporary pain and loss of movement in both arms and both legs. Severe bruising of the spinal cord can result in permanent quadriplegia (loss of movement and feeling in the arms and legs).

Diagnosis and treatment
A suspected spinal cord injury should be treated as a medical emergency, with the health care provider taking full precautions to protect your spine and to transport you by ambulance to the hospital. X-rays of the cervical spine are taken to find out what is causing the symptoms. If your spinal canal is narrowing, the x-rays can expose the condition. Sometimes, they reveal other problems including congenital fusion (permanent union of two vertebrae), degenerative changes, fractures, and damage to the ligaments (tissue connecting two bones) that contribute to the symptoms.

To treat your neck injury, the doctor prescribes medication and rest and immobilizes your neck with a cervical collar. In certain cases, you need surgery to correct the problem and relieve the symptoms.

Can I still play sports?
Your health care provider decides whether you can return to contact sports. You cannot return to play if you have temporary quadriplegia accompanied by cervical instability (excessive motion between the vertebral bodies), a spinal fracture, a recent disc herniation (disc bulging into the spinal canal), or significant degenerative changes. If you have had repeated episodes of temporary quadriplegia, you should not participate in contact sports. Returning to practice or competition with one of these conditions may result in severe, permanent damage to the nervous system.

Researchers have found that certain athletes who have had one episode of temporary quadriplegia but no accompanying injuries can return to contact sports without an increased risk of permanent nerve damage.1 If the health care provider allows you to return to contact sports, you first need to regain maximum strength in your neck by stretching and strengthening the muscles. If you play football, avoid using your head to tackle and modify your shoulder pads according to your health care provider's directions.

Long-term problems
Degenerative disc disease (wearing down of shock-absorbing structures between vertebrae), bone spurs (overgrowth of bone), or vertebral subluxation (one vertebral body slipping forward onto the next) further narrows the spinal canal as the person with cervical spinal stenosis ages. These changes can lead to long-term spinal cord compression, resulting in loss of nerve function such as numbness, weakness, and loss of fine motor control in the arms and hands and difficulty with walking. Sometimes, symptoms are so severe that you need surgery to relieve them. Figure 2 shows the magnetic resonance imaging scan of a person with congenital stenosis of the cervical spinal canal and accompanying degenerative disc disease that is compressing the spinal cord. This person needed decompression (surgical relief of pressure on the spinal cord and nerve roots) and spinal fusion to relieve the symptoms.

Congenital stenosis of the cervical spinal canal puts athletes at risk for nerve injuries. Symptoms of these injuries are usually temporary; however, you must have a health care provider examine your neck to determine the extent of the injury and whether you can return to contact sports. For long-term problems associated with the condition, your health care provider has treatment options available to help relieve your symptoms.

John D. Dorchak, M.D.
Columbus, Georgia

Further reading

1. Torg JS. Cervical spinal stenosis with cord neurapraxia and transient quadriplegia. In: Torg JS, Shephard RJ, eds. Current Therapy in Sports Medicine, third ed. St. Louis, MO: Mosby-Year Book, Inc., 1990; 57-60.

2. Torg JS. Risk factors in congenital stenosis of the cervical spinal canal. In: The Cervical Spine Research Society, ed. The Cervical Spine, second ed. Philadelphia, PA: JB Lippincott Co., 1989;272-285.

3. Watkins RG, Dillin WH, Maxwell J. Cervical spine injuries in football players. In: The Spine in Sports. Hochschuler SH, ed. Philadelphia, PA: Hanley & Belfus, Inc., 1990;157-174.