Cervical Stenosis Specialist · Naples & Fort Myers, FL
Cervical Stenosis. The cord cannot recover what it loses. Timing matters.
Cervical spinal stenosis compresses the spinal cord or nerve roots in the neck, causing myelopathy, radiculopathy, or both. Unlike lumbar stenosis, cord compression is time-sensitive — earlier decompression leads to better neurological recovery. Dr. Katsevman offers every surgical option for cervical stenosis and selects the right one for each patient’s anatomy and goals.
"Myelopathy is the one condition in spine surgery where waiting is genuinely dangerous. The cord loses function it may never get back. Early evaluation and timely decompression change outcomes dramatically."
Dr. G. Katsevman, MD · Neurosurgeon & Spine Surgeonright approach for your anatomy
hidden in neck crease
surgery = better recovery
most cervical procedures
Understanding the condition
What is cervical spinal stenosis?
The cervical spine — your neck — houses the spinal cord itself as it travels from the brainstem to the lower back. When the cervical canal narrows from disc degeneration, bone spurs, facet arthritis, or ligament thickening, these structures compress the cord or the nerve roots exiting at each level.
This is what makes cervical stenosis fundamentally different from lumbar stenosis. In the lumbar spine, the canal contains individual nerve roots — compressing them causes pain and weakness, but the cord itself is not at risk. In the cervical spine, the cord is directly in the canal. Compression of the cord (myelopathy) causes a progressive, potentially irreversible neurological injury. The cord cannot regenerate what it loses — making cervical stenosis with myelopathy one of the conditions in spine surgery where timing genuinely matters.
Why cervical stenosis requires prompt evaluation
The spinal cord has limited capacity for recovery. When it is compressed over months to years, it undergoes progressive injury at the cellular level — a process called myelomalacia (cord signal change visible on MRI). This damage accumulates silently, often before the patient perceives dramatic symptoms. By the time significant functional loss is evident, some of it may be permanent.
Patients who are decompressed early — before significant signal change develops and before major motor deficits are established — consistently achieve better neurological recovery than those who wait until symptoms are severe. If your MRI shows cord compression, the right time to be evaluated by a spine surgeon is now — not after symptoms worsen further.
Two distinct presentations
Myelopathy vs. radiculopathy — which do you have?
Cervical stenosis can compress the spinal cord, the nerve roots, or both simultaneously. Myelopathy and radiculopathy have very different symptoms, different urgency levels, and sometimes different surgical approaches. Understanding which presentation you have is the most important step in your evaluation.
What it is: The spinal cord itself is being compressed. The cord transmits signals between the brain and the entire body — cord compression disrupts these signals globally
Hand symptoms: Clumsiness, dropping objects, difficulty with fine motor tasks — buttoning a shirt, typing, writing. Often the earliest and most diagnostic sign
Gait symptoms: Balance problems, unsteady walking, tendency to fall, difficulty on stairs or uneven surfaces. A broad-based spastic gait is a late sign
Lhermitte’s sign: An electric shock sensation shooting down the spine or into the arms and legs when flexing the neck — a classic sign of cord involvement
Bilateral symptoms: Myelopathy typically causes symptoms in both arms and/or both legs, distinguishing it from radiculopathy which is usually one-sided
Urgency: High. Cord compression is progressive and the damage is partially irreversible. Earlier decompression = better neurological recovery. Do not wait until symptoms are severe
What it is: A single nerve root exiting the cervical spine is compressed by a disc herniation or bone spur, causing symptoms in the arm territory that nerve supplies
Arm pain: Shooting, burning, or electric pain radiating from the neck into the shoulder, arm, and hand. Often the most disabling symptom — patients describe it as unbearable and constant
Dermatomal pattern: Numbness and tingling in a specific distribution corresponding to the compressed nerve level — thumb and index finger, middle finger, ring and little finger, or a broader arm pattern
Weakness: Focal weakness in muscles supplied by the compressed root — shoulder abduction, elbow flexion, wrist extension, grip — depending on the level
One-sided: Unlike myelopathy, radiculopathy is almost always unilateral — one arm, one side. Bilateral arm pain suggests cord involvement
Urgency: Moderate. Most cases are treated conservatively first. Surgery is considered after 6 weeks of failed conservative care, or sooner if weakness is progressive
Recognizing your symptoms
What cervical stenosis feels like
Symptoms vary dramatically depending on whether myelopathy, radiculopathy, or both are present. Here are the patterns that should prompt evaluation.
Hand Clumsiness & Fine Motor Loss
Difficulty buttoning a shirt, fumbling with keys, dropping cups or utensils, deteriorating handwriting, difficulty typing. Often the first and most specific sign of cervical myelopathy — patients frequently attribute it to "getting older" rather than recognizing it as a neurological warning sign.
Balance Problems & Unsteady Walking
Tendency to stumble on uneven ground, difficulty walking in the dark (when visual compensation is removed), holding walls for support, falls. A broad-based spastic gait — walking with feet wide apart — is a later sign of significant cord involvement.
Arm Pain & Radiculopathy
Shooting, burning, or electric pain from the neck into the shoulder, upper arm, forearm, or hand. Often follows a specific pattern corresponding to the compressed nerve root level. Frequently the most severe and distressing symptom — patients describe it as impossible to escape regardless of position.
Arm or Hand Numbness & Tingling
Pins-and-needles, a dead or numb feeling in specific fingers or the whole hand. The distribution of numbness — which fingers, which part of the arm — corresponds to the specific nerve root being compressed and helps localize the stenosis level on MRI.
Arm or Leg Weakness
Weakness in the arms from nerve root compression, or weakness in the legs from cord compression (myelopathy). Cord-related leg weakness is particularly important — a patient who notes their legs feel heavy, stiff, or unreliable while walking may be experiencing early myelopathic motor dysfunction.
Lhermitte’s Sign
An electric shock sensation that travels down the spine, into the arms, or into the legs when the neck is bent forward. Classic sign of spinal cord irritation or compression. If you experience this — even briefly — it warrants prompt MRI evaluation and spine surgery consultation. It is not a normal sensation.
⚠ Seek urgent evaluation for these symptoms
Cervical myelopathy can progress to significant permanent disability without surgical intervention. These symptoms warrant prompt — not routine — evaluation:
- Rapidly worsening hand function or grip strength — acute cord compression can cause rapid, potentially irreversible motor loss
- New or worsening gait instability or falls — cord-mediated balance dysfunction often signals significant stenosis
- Bilateral arm weakness or heaviness — bilateral symptoms suggest cord rather than nerve root involvement
- Bowel or bladder changes — rare in cervical stenosis but indicates severe cord compression; go to the emergency room immediately
- Lhermitte’s sign — any electric sensation with neck movement warrants urgent MRI
If symptoms are rapidly progressing, go to the nearest emergency room or call 911 rather than scheduling a routine appointment.
Surgical options
Four approaches — one chosen for your anatomy
There is no single “cervical stenosis surgery.” Dr. Katsevman performs all four major cervical decompression approaches and selects based on the patient’s specific anatomy, the number of levels involved, the degree of cord compression, whether radiculopathy or myelopathy predominates, and individual factors like bone quality and prior surgery.
The most commonly performed cervical spine surgery — and the gold standard for the majority of cervical stenosis presentations. Access is through the front of the neck through a lipstick-sized incision hidden in the natural neck crease. No muscles are cut. The diseased disc and compressive bone spurs are removed, the cord and nerve roots are decompressed, and an interbody cage and plate stabilize the level.
Best for: Radiculopathy, myelopathy, or both. Works at any cervical level. Highly reliable outcomes. Same-day or next-day discharge. Neuromonitoring on every case. Prevertebral steroids to minimize swallowing issues. Level-by-level technique for multi-level cases.
For appropriate candidates, disc replacement preserves motion at the treated level instead of fusing it, protecting adjacent discs from accelerated degeneration. Same anterior approach, same incision, same decompression — but instead of a cage and plate, an artificial disc is implanted that allows continued movement.
Best for: Radiculopathy or mild myelopathy in patients with adequate facet joints, no significant instability, and no contraindications to motion preservation. Dr. Katsevman offers both Simplify® (Globus Medical) and ProDisc-C® (Centinel Spine) — he is listed on the surgeon locator for both devices. 4× fewer reoperations at 7 years vs. fusion.
When stenosis spans multiple cervical levels, a posterior approach (from the back of the neck) allows decompression of all levels simultaneously without the risks associated with a multi-level anterior approach. The laminae and thickened ligamentum flavum are removed, directly opening the canal from behind across as many levels as needed.
With or without fusion: In patients with adequate cervical lordosis (normal neck curve), laminectomy alone may be sufficient. When the cervical spine is kyphotic (reversed curve) or when instability is present, lateral mass screws and rods are added to stabilize the construct — a cervical laminectomy and fusion. The decision is anatomy-driven, not routine.
Best for: Multi-level cervical myelopathy, particularly when 3 or more levels are involved, when anatomy is not suitable for anterior multi-level surgery, or when posterior decompression is technically preferred.
Laminoplasty is a posterior technique that expands the spinal canal without removing the laminae entirely and without fusing the spine. The laminae are cut on one side and hinged open on the other, like opening a door, and held in the expanded position with small titanium plates. The canal is enlarged and the cord is decompressed — but the posterior anatomy is preserved and motion is maintained.
Why it matters: In patients with multi-level myelopathy who have preserved cervical lordosis and no instability, laminoplasty avoids the permanence of fusion while still achieving multi-level cord decompression. It is particularly valuable in patients who are physically active and want to preserve as much neck motion as possible.
Best for: Multi-level cervical myelopathy with preserved lordosis and no instability, in patients where posterior motion preservation is a priority. Not appropriate when kyphosis is present.
Treatment ladder
From conservative care to surgery
For radiculopathy without significant myelopathy, conservative care is always tried first. For myelopathy with cord signal change or progressive deficits, surgical planning should begin promptly.
Conservative non-surgical care
For cervical radiculopathy without significant cord involvement, a structured trial of conservative care is appropriate. Most cervical radiculopathy episodes improve within 6–12 weeks with the right approach.
Physical therapy — cervical traction relieves foraminal compression by gently distancing vertebrae and opening the neural foramen. Postural correction and strengthening address the dynamic factors contributing to nerve root irritation. Nerve gliding exercises restore mobility along the nerve tract.
Anti-inflammatory medications — NSAIDs, short oral steroid courses, and neuropathic pain agents (gabapentin, duloxetine) address the inflammatory and neuropathic components of arm pain.
Cervical collar — a soft collar worn periodically can offload the facet joints, restrict provocative motions, and provide short-term symptom relief during acute flares — not for long-term use.
Cervical epidural steroid injections
When physical therapy and oral medications are insufficient, a cervical epidural steroid injection delivers corticosteroid directly to the compressed nerve root, reducing inflammation and often dramatically reducing arm pain within days. This can break the acute pain cycle and allow physical therapy to progress, potentially avoiding or delaying surgery.
Important limitation: Injections address the inflammatory component of nerve root pain. They do not decompress the canal, and they are not an effective treatment for myelopathy — cord compression requires structural decompression, not anti-inflammatory medication.
Surgery — decompress before the cord loses more
Surgery is indicated when conservative care fails after an adequate trial for radiculopathy, when weakness is progressive, when cord signal change (myelomalacia) is present on MRI, or when myelopathy symptoms are affecting function and quality of life. The specific approach — ACDF, disc replacement, laminectomy, or laminoplasty — is chosen based on the anatomy and presentation described above.
The most important message: For myelopathy specifically, the goal of surgery is not just symptom relief — it is halting the progression of cord injury and preserving the neurological function that remains. The earlier decompression occurs relative to the onset of cord injury, the more complete the recovery.
Learn more
From Dr. Katsevman’s blog
Plain-language guides on cervical stenosis, myelopathy, and your surgical options.
Common questions
What patients ask most
How do I know if I have myelopathy or just radiculopathy? +
Radiculopathy is one-sided arm pain, numbness, or focal weakness corresponding to a specific nerve root. It does not affect balance, hand coordination globally, or the legs. Myelopathy involves the cord — it typically causes bilateral symptoms, hand clumsiness (not just arm pain), gait instability, Lhermitte's sign (electric shock with neck flexion), and in advanced cases, leg heaviness or spasticity. Many patients have both simultaneously. The clinical examination and MRI — particularly the presence of cord signal change (myelomalacia on T2-weighted imaging) — are the definitive tools for distinguishing them. If you have any balance issues, hand clumsiness, or Lhermitte's sign, assume cord involvement until proven otherwise and be evaluated promptly.
How urgent is cervical myelopathy — can I wait a few months? +
It depends on severity and trajectory. Mild, stable myelopathy without cord signal change on MRI can sometimes be monitored for a defined period while being evaluated. But if your symptoms are worsening — even slowly — or if your MRI shows cord signal change (white signal on T2 MRI within the cord), waiting is risky. The cord cannot regenerate damaged tissue. Each month of compression at the level of the cord is a month of cumulative injury. Patients who are decompressed before significant cord signal change develops consistently recover better than those who wait until symptoms are severe or signal change is established. The right answer for your specific case requires an in-person or telemedicine consultation — not a general rule.
How does Dr. Katsevman decide between ACDF and disc replacement for cervical stenosis? +
The decision depends on several factors. Disc replacement is appropriate for patients with radiculopathy or mild myelopathy who have intact facet joints, preserved disc height, no significant instability, and no osteoporosis or prior cervical surgery at that level. ACDF is preferred for moderate-to-severe myelopathy where fusion provides more reliable decompression and stability, multi-level disease beyond disc replacement's approved indications, patients with facet arthritis or anatomy not suited to motion preservation, or whenever the surgeon judges that fusion is the more reliable choice for that specific anatomy. Dr. Katsevman is on the surgeon locator for both Simplify® and ProDisc-C® devices — he performs both routinely and recommends whichever is genuinely better for each patient's anatomy, not based on preference or training bias.
What is cervical laminoplasty and when is it better than ACDF? +
Laminoplasty is a posterior procedure that expands the cervical canal by hinging the laminae open and holding them in the expanded position with titanium plates — without removing the laminae or fusing the spine. It decompresses the cord across multiple levels simultaneously while preserving posterior motion. It is particularly valuable when 3 or more levels of myelopathy are present, when the cervical lordosis is well-preserved, and when the patient is a good candidate for posterior surgery. It avoids multi-level anterior surgery and preserves motion — but it cannot address anterior compression directly, works best when lordosis is maintained, and is not appropriate when kyphosis is present. ACDF is preferred for focal disease, kyphosis, or when direct anterior decompression of a specific disc level is needed.
Will I recover from cervical myelopathy after surgery? +
Surgery for myelopathy stops the progression of cord injury and often leads to meaningful neurological recovery — but the degree of recovery depends on how much cord damage occurred before decompression. Patients with mild to moderate myelopathy who are decompressed before significant cord signal change typically experience substantial improvement in hand function, balance, and arm symptoms. Patients with established cord signal change or long-standing severe myelopathy may experience stabilization with partial — rather than complete — recovery. This is the core reason that prompt evaluation and timely surgery matter: the less cord damage that accumulates before decompression, the more there is to recover from. Waiting for symptoms to become severe before seeking evaluation is the single biggest factor limiting recovery.
Can I get a second opinion on my cervical stenosis treatment? +
Absolutely — and for cervical stenosis specifically, a second opinion can be particularly valuable given the range of available surgical approaches. Patients are sometimes offered only ACDF when disc replacement or laminoplasty might be a better fit for their anatomy. Others are told to "watch and wait" when cord signal change on their MRI warrants more urgent action. Dr. Katsevman offers in-person and telemedicine second-opinion consultations for cervical stenosis and myelopathy patients across Florida and nationally. Bring your MRI and any prior surgical recommendations. The conversation often either confirms the plan with added confidence or identifies a better approach.
"Cervical myelopathy is one of the few conditions in spine surgery where I tell patients: don’t wait. The cord has a limited window. Early decompression changes what is recoverable."
Gennadiy (Gene) A. Katsevman, MD
Neurosurgeon & Minimally Invasive Spine Surgeon
Performs all four cervical decompression approaches: ACDF, cervical disc replacement, cervical laminectomy ± fusion, and cervical laminoplasty
Listed on surgeon locator for Simplify® Cervical Disc (Globus Medical) and ProDisc-C® (Centinel Spine)
Neuromonitoring on every cervical case; prevertebral steroids routinely at end of every ACDF
Corus® MIS posterior cervical facet cages for pseudoarthrosis-risk patients — performed by select few surgeons nationally
Fellowship-trained at Barrow Neurological Institute — one of the world’s premier cervical spine surgery centers
Neurosurgery residency, West Virginia University — Level 1 Trauma Center
30+ peer-reviewed publications in spine surgery and neurosurgery
Naples Top Doctor in Neurosurgery — 2024, 2025, and 2026
5-star Google rating · Healthgrades Choice Provider · WebMD Preferred Provider
Take the next step
Cord compression is time-sensitive.
Don’t wait to be evaluated.
Schedule a consultation with Dr. Katsevman in Naples or Fort Myers — or by telemedicine from anywhere. Bring your MRI. Find out which approach is right for your anatomy and how urgent your situation is.
6101 Pine Ridge Road #101
Naples, FL 34119
Fort Myers, FL 33919
Available statewide & nationally