History of Neck Spinal Stenosis
The history is the patient’s story: how the symptoms began, where the symptoms are located, what is the interference in the quality of life, what relieves and what aggravates. Cervical (neck) spinal stenosis is the narrowing of the spinal canal which reduces the space available for the spinal cord. 
Cervical (neck) spinal stenosis produces symptoms due to spinal cord compression. If the spinal canal in the neck is narrow enough, then the natural motion of the neck may compress the spinal cord. In flexion (bending the neck forward), the spinal cord may be compressed against structures on the floor of the canal (bone spur, disc). In extension, the spinal canal becomes narrower and the spinal cord can be compressed by both the roof structures indenting the spinal cord from behind and driving the cord against the front structures on the floor.
Compression in the neck effects the spinal cord and potentially produces symptoms in the arms, legs and occasionally the bowel and bladder. Compressing the spinal cord is frequently painless. Patients with cord compression that develops slowly may experience numbness in the hands, clumsiness in the hands, shooting numbness down the trunk, arms or legs with neck motion, balance difficulties when walking, an unsteady gait and occasionally disturbance in bowel and bladder function.

Physical Exam of Spinal Stenosis
The physical exam is performed by the doctor to determine the effects of stenosis. An examination of the function of the nerves in the arms and legs may reveal weakness, numbness or reflex change. Abnormal reflex patterns may appear with long standing spinal cord compression. 

Different degrees of spinal cord compression, and how fast it develops determines the physical exam. The patient's physical examination may be normal or extremely abnormal (wheel chair bound as an extreme). 

Diagnostic Studies for Spinal Stenosis
The purpose of diagnostic studies is to answer the question, “where on the electrical diagram is the interruption that explains the patient’s clinical situation.” Diagnostic studies are designed to produce a picture of the interruption (MRI, Myelogram, C.A.T. scan) or to indicate electrical interference of the spinal nerves. (EMG or SSEP). The diagnostic studies must correlate with (explain) the patient’s history and physical exam to be meaningful. Many tests show age related changes that exist in people who do not have pain. (there are people who have spinal stenosis who do not have any symptoms and degenerative changes are common in the spine as patients mature)

TREATMENT OF SPINAL STENOSIS
 
Natural History
| The natural history is the rate that nature cures a particular condition. Nature has been curing things for 3 billion years and a certain percentage of patients with a particular diagnosis are going to be healed by nature. Different patterns of clinical symptoms from cervical (neck) spinal stenosis can be expressed: slow gradual onset of symptoms with a progressive decline in function, sudden change with rapid decline in function and a series of episodes leading to decline during the episodes and then periods with no clinical change until the next episode. 

A point can be reached where the spinal canal narrows so much that there is no space available for the cord. This is critical narrowing. Critical narrowing is a concept of lack of space. After all the spinal cord occupies space and needs sufficient room. The normal spinal cord has a defined oval shape. When compressed from either the floor or the roof or both, the spinal cord shape adapts to the pressure which interrupts the function of the spinal cord and produces symptoms in the extremities. 

Conservative Care
The purpose of conservative care is to relieve symptoms and improve function. The critical issue in cervical spinal stenosis with cord compression is the evaluation of the patient's clinical situation (history, physical exam, diagnostic studies) to determine if any conservative care is appropriate or whether surgery is the "conservative option."

Surgery
The goal of surgery is to take pressure off the spinal cord. Different surgical options for cervical spinal stenosis involve anterior (floor) approach, posterior (roof) approach, and sometimes a combined floor and roof approach. Some operations decompress the spinal cord (remove pressure) only, others decompress the spinal cord and stabilize the cervical (neck) spine (fusion, +/- instrumentation). Different approaches, anterior vs. posterior and surgical strategies (decompression and/or stabilization) are employed depending on the patient's particular circumstance. 
 
Conclusion
Spinal stenosis is narrowing of the spinal canal. The effect of spinal canal narrowing is to reduce the space available for the spinal cord. This reduction in space may lead to spinal cord compression and therefore symptoms in the arms or legs. The impact of stenosis on a particular patient can vary from minimal to severe. The choice of treatment for spinal stenosis involves the patient determining how the symptoms of spinal stenosis effects the patient’s quality of life and balancing two competing risks: the risk of surgery vs. the risk of not having surgery. The strategy of surgery for spinal stenosis is to alter the anatomy to eliminate spinal cord compression.