When cervical spinal stenosis is severe, various symptoms may develop which include pain, weakness in arms and/or legs and unsteadiness in the gait (myelopathy).

For mild conditions conservative treatment may be sufficient. When symptoms are severe or progressive then a surgical treatment may be necessary. Surgical goals include a decompression of all compressed levels of the spine and stabilization with solid fusion. Surgical techniques are very dependant upon the specific problems of each patient. Anterior and posterior surgical approaches can be applied. In certain cases a decompression laminoplasty without fusion may be employed (laminoplasty consists of a careful splitting of the laminae which are then held apart in order to enlarge the spinal canal diameter).

The main approach in conservative treatment for stenosis in the elderly focuses on stabilization of the spine. In order to pursue enhanced conditioning and stabilization of the spine, an exercise program and limited bracing may be helpful. Many brace types are available, an LSO (Lumbosacral orthosis) can offer relief if properly fitted and worn. One brace type which is commonly employed is called " V-Loc ". This brace should be worn most hours of the day, and it takes about two weeks to get used to wearing a brace which will be uncomfortable during the first days, but then be tolerated progressively better and better. When the brace is tolerated the patient can start an exercise program for strengthening of the arms, legs, and indirectly the back muscles. In some cases epidural steroid injections can offer temporary relief. Pain medication and anti-inflammatory drugs can also be effective options.

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Steroids are a category of compounds which have the effect of reducing the inflammatory pathways. There are many conditions for which steroids are taken by mouth in order to decrease inflammation somewhere in the body. In the case of epidural injections, a small amount of steroid solution is injected into the region around the spinal nerves. The goal of such injections is to decrease the inflammation surrounding the nerves and thereby reduce pain and other symptoms associated with an irritated nerve. Some common conditions for which epidural injections are given include: central spinal stenosis, foraminal stenosis, and radiculitis. The effectiveness of these injections is variable and often relief is temporary. Prior to considering any treatment it is important to obtain a thorough evaluation from a spine specialist.

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