This chapter deals with the brief discussion of cervical canal stenosis. It is the most common cause of cervical cord compression and myelopathy. The stenosis is usually due to a progressive decrease in cervical canal size with degenerative changes, commonly called as cervical spondylotic myelopathy (CSM). Cervical canal stenosis is of two types i.e. congenital and acquired. The cervical canal is wider at C1–C2 levels and narrows down to a uniform sagittal diameter from C3 to C7. Plain radiographs have the ability to evaluate only osseous structures contributing to stenosis. However, soft-tissue intrusions, like discoligamentous protrusions, hypertrophied posterior longitudinal ligament (PLL) or ligamentum, contribute to a major extent towards degenerative canal stenosis. There have been several theories to explain the progression of myelopathy with degeneration in the cervical spine such as mechanical theory, compression theory, etc. It is important to know the natural history, for decision making in the management of CSM. The primary goal of surgery is to relieve compression on the spinal cord.