By Mr Ahmed-Ramadan Sadek, Neurosurgeon · Last reviewed October 2026 · 7 min read

What are cervical stenosis and myelopathy?

The spinal cord runs down through a bony tunnel in the neck, the spinal canal, carrying messages between your brain and the rest of your body. Branches called nerve roots leave it at each level to supply the arms.

Stenosis means narrowing. With time, the discs between the neck bones lose height and can bulge backwards, the small joints thicken with arthritis, ligaments stiffen and bony spurs (osteophytes) form. Together these can shrink the space available for the cord. Less commonly, a cyst or tumour narrows the canal.

Myelopathy means the spinal cord itself is not working properly because it is being compressed. Doctors often call the age-related form degenerative cervical myelopathy. It is different from cervical radiculopathy, where a single nerve root rather than the cord is pinched, although the two can occur together.

Symptoms to look out for

Myelopathy usually develops gradually. Symptoms may stay stable for years and then worsen fairly quickly. Many people first see a doctor because of arm pain or tingling, and the signs of cord compression are picked up during the examination. Look out for:

• Hands that feel numb, tingly or ‘fizzy’ and have become clumsy
• Difficulty with fiddly tasks such as writing, using buttons or picking up coins
• Poor balance, stumbling or bumping into things, as if slightly unsteady on your feet
• Legs that feel heavy or stiff, and being unable to walk quickly
• Brief electric-shock sensations down the arms or legs, particularly when bending the head forwards
• In more advanced cases, changes in bladder or bowel control

Left untreated, severe myelopathy can lead to major disability, including loss of use of the arms and legs.

How is it diagnosed?

Your specialist will take a careful history and examine you, looking at hand function, walking, balance and reflexes, which are often brisk when the cord is affected. An MRI scan shows where the canal is narrowed and whether the cord shows signs of strain. X-rays or a CT scan may be added to assess bone and alignment before surgery.

Treatment options

Unlike a trapped nerve, a compressed spinal cord does not usually recover on its own. the British Association of Spine Surgeons (BASS) patient information describes cervical myelopathy as a serious condition in which symptoms are likely to keep progressing without surgery. People with very mild findings are sometimes monitored closely, but most people with definite myelopathy are advised to consider an operation.

The purpose of surgery is to decompress the cord, taking the pressure off it, and so halt further damage. Results vary, because some people already have more cord injury than others. After surgery, some patients notice modest gains in hand use, walking and sensation, and arm pain often improves. Heavy numbness that was present beforehand may not fully go, and neck pain is not a reliable target. If the operation simply stops the condition getting worse, that is regarded as a success. Earlier treatment generally gives better results.

Types of surgery

The surgeon chooses between an approach from the front or the back of the neck, depending on where most of the pressure comes from and how many levels are involved. Occasionally both are needed, usually on separate occasions. Outcomes from the different techniques are broadly similar.

From the front (anterior)

• Anterior cervical discectomy and fusion (ACDF): one or more worn discs and their bony spurs are removed through a small cut in the front of the neck, and each gap is filled with a cage and/or bone graft so the bones fuse. A small plate may be added.
• Anterior cervical corpectomy: where spurs extend behind the vertebral body itself, the surgeon removes part or all of that bone along with the discs either side, replacing it with a cage or strut of bone and usually a plate.

Bone usually takes around 3 to 6 months to fuse solidly.

From the back (posterior)

• Laminectomy: the bony roof of the canal (the lamina) is removed over several levels so the cord can drift backwards into more space. Screws and rods are often added to stop the neck gradually tipping forward.
• Laminoplasty: rather than removing the lamina, the surgeon hinges it open like a door and props it with a small spacer, widening the canal while keeping some movement.
• Laminotomy and skip laminectomy: less extensive variations that remove smaller amounts of bone or treat alternate levels to reduce muscle disruption and avoid the need for fixation.

Risks and complications

Your surgeon will explain how these apply to your particular operation. The figures below are taken from BASS patient information on surgery for cervical stenosis and myelopathy.

Risk	Approximate frequency (BASS)
Nerve root injury (first operation)	Less than 1 in 100
Nerve root injury (repeat operation)	Up to 10 in 100
Tear in the nerve lining (dura)	Fewer than 5 in 100
Further surgery to repair a fluid leak	Less than 0.05%
Superficial wound infection	Up to 4 in 100
Deep wound infection	Fewer than 1 in 100
Blood clot in the leg or lung (DVT/PE)	Fewer than 1 in 100
Bone not fusing (non-union)	Up to 5 in 100
Cage or graft shifting (front approach)	Up to 2 in 100; about 1 in 100 need re-operation
Injury to windpipe or gullet (front approach)	Fewer than 1 in 100
Drooping eyelid, usually temporary (front approach)	Less than 1 in 100
Death from major blood vessel injury	About 1 in 10,000
Fatal general anaesthetic complication	About 1 in 250,000

Other risks, for which BASS gives no precise figure, include temporary hoarseness or swallowing difficulty after front-of-neck surgery; bleeding with neck swelling that may need a return to theatre; injury to the vertebral artery during corpectomy or screw placement, which could cause a stroke; persistent or returning symptoms; and, rarely, spinal cord injury causing paralysis. Problems may also develop at neighbouring levels in later years.

Recovery and outlook

Most people stay in hospital for 1 to 2 days. Any improvement in hand function or walking tends to be gradual and may continue for a year or so. A small number of people benefit from a period of specialist neurological rehabilitation.

• Driving: usually after 2 to 4 weeks, once you can turn your head freely, have normal arm control and can stop safely in an emergency.
• Work: many people return after about four weeks, or up to eight weeks for heavy jobs; those with more severe pre-existing damage may need longer.
• Activity: walk often, avoid heavy lifting for the first weeks to three months, and check before resuming sport.
• Follow-up: X-rays are commonly taken at clinic visits to check healing and implant position.

• BASS patient booklet: Cervical Stenosis and Myelopathy
• Myelopathy.org: patient charity for degenerative cervical myelopathy
• Spinemathema: Neck disc prolapse and arm pain
• Spinemathema: MRI scanning of the spine

This guide is general information and is not a substitute for advice about your own situation. Please speak to your GP or specialist.