Background Congenital cervical stenosis (CCS) is a rare condition involving a narrowed spinal canal due to developmental anomalies. CCS heightens the risk of neurologic deficits and acute spinal cord injury post-trauma, influencing return-to-play decisions for contact athletes. Additionally, CCS patients are prone to cervical myelopathy as degenerative changes progress with age. Limited evidence-based literature exists on the epidemiology of CCS, including racial effects. We sought to investigate the incidence of CCS as it pertains to race and ethnicity. Methods We screened 5395 cervical MRIs from a single institution and identified CCS by a sagittal canal diameter (SCD) of less than 10 mm at 2 or more vertebral levels (C3-7) at the pedicle. Exclusion criteria included patients under 18 and over 50 years, prior cervical spine surgery, congenital fusions, spinal column malignancy, or active smoking history. For each patient, axial measurements were taken at each level, including coronal vertebral body length, anteroposterior vertebral body length, pedicle width, pedicle length, laminar length, anteroposterior lateral mass length, posterior canal distance, apex-to-vertebral body, lamina-disc angle (LDA), lamina-pedicle angle, and anteroposterior spinal cord diameter. Results A total of 343 patients met the criteria for CCS: 100 White, 98 Black, 70 Asian, and 75 Hispanic. CCS prevalence varied significantly among ethnic groups; Black (39.3%), Asian (33.6%), and Hispanic (22%) patients had higher CCS rates than White patients (7.5%) x2 (3, N=343) = 30.04, p <0.05. The Interrater Correlation Coefficient for the SCD measurements across all levels and patients demonstrated excellent reliability (ICC = 0.926, 95% CI: 0.91-0.94). Black and Asian patients showed consistently smaller SCDs at all pedicle levels compared to White patients, who had the largest SCDs overall (p<0.001). Average SCDs were 11.4 mm (White), 10.4 mm (Black), 10.5 mm (Asian), and 11 mm (Hispanic). Additionally, LDAs were larger in Asians, Blacks, and Hispanics compared to Whites, reducing cross-sectional canal area (p<0.001). Conclusion Our study indicates a significant correlation between race/ethnicity and CCS prevalence. Black and Asian patients had the highest CCS rates, smallest SCDs, and largest LDAs. These anatomical differences suggest an increased risk of cervical myelopathy and neurological issues, particularly for contact sport athletes. This emphasizes the need for personalized clinical management and early intervention to address healthcare disparities and improve outcomes in vulnerable populations.