Asymptomatic Cervical Stenosis: To Operate or Not?

Asymptomatic cervical stenosis is a relatively common condition that is being diagnosed more frequently during the evaluation of other disorders with the use of new noninvasive imaging techniques such as magnetic resonance imaging. Although the annual risk of spinal cord injury and cervical myelopathy due to cervical stenosis appears to be small, the long-term cumulative risk of cervical stenosis in the young or middle-aged patient can be significant and may justify surgical consideration. In older patients, where life expectancy is lower and risk of surgical complications is greater, it is likely more prudent to closely observe these patients until symptoms arise. Patient education about the symptoms of myelopathy and close observation is required for all patients. A detailed history and physical examination may also detect subtle signs or symptoms of myelopathy that were not previously appreciated. There is a need for further clinical study of the role of surgery in asymptomatic patients with significant cervical stenosis.