Central Canal Stenosis

Spinal stenosis is the narrowing of one or more bony openings (foramina) in the vertebrae of the spine. When spinal stenosis occurs in the spinal canal, it is called central canal stenosis and may cause compression of the spinal cord.

The signs and symptoms of central canal stenosis may be felt on either or both sides of the body and may include sharp, shock-like pain, tingling, numbness, and/or weakness that may radiate into the arms or legs. Changes in movement-coordination and paralysis may occur in severe central canal stenosis. This article highlights the specific symptoms, causes, and treatments of central canal stenosis in the neck (cervical), upper back (thoracic), and lower back (lumbar) regions.

How Central Canal Stenosis Affects the Spinal Cord

The spinal cord descends from the brain, traveling down through the neck and ending at the upper part of the low back. Spinal nerves branch off from the spinal cord at each spinal segment through intervertebral foramina between adjacent vertebrae. A bundle of nerves descends from the bottom of the spinal cord to form the cauda equina.

The development of bone spurs (osteophytes) and disc disease in the spine can constrict the space for the spinal cord, causing one or both of the following:¹Meyer F, Börm W, Thomé C. Degenerative cervical spinal stenosis: current strategies in diagnosis and treatment. Dtsch Arztebl Int. 2008;105(20):366–372. doi:10.3238/arztebl.2008.0366

• Compression of the spinal cord in the cervical, thoracic, and/or lumbar spine
• Compression of the cauda equina in the lumbar spine

Spinal cord compression in the neck may cause bending or twisting of blood vessels that supply the spinal cord and the brain.¹Meyer F, Börm W, Thomé C. Degenerative cervical spinal stenosis: current strategies in diagnosis and treatment. Dtsch Arztebl Int. 2008;105(20):366–372. doi:10.3238/arztebl.2008.0366

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Central Canal Stenosis Signs and Symptoms

Central canal stenosis may not always cause pain or other symptoms. If symptoms occur, different regions of the body may be affected based on the location of the stenosis, as described below:

• Central stenosis of the cervical spine may cause neck, shoulder, and/or arm pain. Additionally, numbness and/or weakness in the arms with or without difficulty in balance and walking may occur.²Kadanka Z, Adamova B, Kerkovsky M, et al. Predictors of symptomatic myelopathy in degenerative cervical spinal cord compression. Brain Behav. 2017;7(9):e00797. Published 2017 Aug 11. doi:10.1002/brb3.797
• Central stenosis of the thoracic and lumbar spine mostly affects the lower back, buttocks, thighs, and legs, causing pain and/or numbness.

In severe cases, paralysis below the level of injury with the loss of bowel and/or bladder control is possible. It is common to start stooping forward and become less active as the signs and symptoms begin to progress.³Melancia JL, Francisco AF, Antunes JL. Spinal stenosis. In: Handbook of Clinical Neurology. Elsevier; 2014:541-549. doi:10.1016/b978-0-7020-4086-3.00035-7

The Course of Central Canal Stenosis

Typically, stenosis is seen in up to 80% of people above 60 years of age, with an estimated 5% having coexisting cervical and lumbar stenosis (also called tandem spinal stenosis).³Melancia JL, Francisco AF, Antunes JL. Spinal stenosis. In: Handbook of Clinical Neurology. Elsevier; 2014:541-549. doi:10.1016/b978-0-7020-4086-3.00035-7 Men are usually affected more than women.⁴Adams TL, Marchiori DM. Chapter 9: Arthritides. In: Marchiori DM. Clinical Imaging. Elsevier; 2014. doi:10.1016/c2009-0-42800-9 Spine surgery in people over 65 years is most commonly performed for treating spinal stenosis.³Melancia JL, Francisco AF, Antunes JL. Spinal stenosis. In: Handbook of Clinical Neurology. Elsevier; 2014:541-549. doi:10.1016/b978-0-7020-4086-3.00035-7

Stenosis typically develops over time as a result of natural changes in the spine, although trauma, metabolic conditions, infections, and previous surgery may aggravate or advance this condition. The signs and symptoms, however, may occur suddenly or slowly, causing pain, numbness, and/or weakness in different parts of the body. The lumbar spine is most commonly affected by stenosis, followed by the cervical spine, which, however, progresses faster.³Melancia JL, Francisco AF, Antunes JL. Spinal stenosis. In: Handbook of Clinical Neurology. Elsevier; 2014:541-549. doi:10.1016/b978-0-7020-4086-3.00035-7 Stenosis of the thoracic spine is rare.

While stenosis can typically be managed with nonsurgical treatments, sometimes surgery may be required. Nonsurgical treatments are usually tried for 3 months (or more) before surgically treating spinal stenosis.³Melancia JL, Francisco AF, Antunes JL. Spinal stenosis. In: Handbook of Clinical Neurology. Elsevier; 2014:541-549. doi:10.1016/b978-0-7020-4086-3.00035-7 The goal of stenosis treatment is to maximize the space within the central canal and to prevent the progression of spinal cord and/or nerve root compression.

When Central Canal Stenosis Is Serious

While all signs and symptoms of central canal stenosis must be evaluated by a doctor, some require immediate medical attention. A few examples include:

• Reduced bowel and/or bladder control and/or numbness in the genital region
• Sudden, severe neck and/or back pain that does not go away
• Foot-dragging on the floor while walking or difficulty in lifting the front part of the foot (foot drop)
• Sudden weakness and/or numbness in any part of the body
• Sudden loss of function in the arms, such as the inability to grip

These signs and symptoms may indicate severe spinal cord and/or spinal nerve compression, tumors near the spine, or cauda equina syndrome, requiring prompt treatment.