Cervical Spondylosis is a condition in which abnormal deterioration of the cervical cartilages and vertebrae causes chronic neck pain. It is usually the result of prior a damage to the neck, including work or life-style activities, although its occurrence is affected by genetic factors because some families show greater changes than others.
Treatments include physical traction and manipulation through anti-inflammatory drugs.
Improved posture, including the provision of neck support during sleep, and choice of lifestyle activities is important in reducing the likelihood of developing this condition.
Because it is often linked to chronic deterioration with age, treatment can be unsatisfactory. Mechanisms tried include the use of traction and physical manipulation through medication with anti-inflammatory drugs. Alternate hot and cold compresses can be valuable in relieving acute attacks of discomfort .
Cervical spondylosis is also known as cervical osteoarthritis, neck arthritis and chronic neck pain.
Prominent presenting signs are:
Depending on which nerves are affected there may be pain or lack of function in dependent areas of the body, notably the arms and hands but occasionally the legs.
Generally the condition deteriorates over time but it may suddenly start or get dramatically worse. The level of pain varies with individuals – it can be mild or deep and excruciating. Severely affected patients may be unable to move .
Radiography- to identify arthritic changes
Magnetic resonance Imaging (MRI) – usually performed when pain does not respond to treatment or when the hands are numb or weak .
Electromyography (EMG) and nerve conduction velocity tests can provide information on the activity of nerve roots.
1. Flare-ups can be ameliorated by alternating cold packs and heat therapy
2. Cognitive behavioural therapy helps patients to understand their condition and manage the pain and assists in developing suitable behaviour patterns.
3. Immobilisation of the neck is the cornerstone of conservative treatment since it reduces nerve irritation. Cervical collars vary between soft and more rigid orthosis, including body jackets.
4. Physical traction to relieve some of the nerve pressure in the neck and other forms of therapy by a registered complementary practitioner, e.g. masseur, acupuncturist, chiropractor or osteopath, are indicated.
5. Prescribed medications to reduce the pain include:
6. Surgery to relieve the pressure on the nerves or spinal cord is performed when there is loss of movement or sensation in a dependent area or severe pain does not respond to any of the above treatments .
Cervical spondylosis usually gives some long-term symptoms. In most cases, these are ameliorated by physical or medical therapy and surgery is not required.
Once the deterioration process has commenced and reached a level of clinical significance, it is likely that it will continue and the patient will always have problems to a certain extent .
The most important risk factor is ageing and most people show signs of cervical spondylosis by the age of about 60. There appears to be a genetic influence due to its higher incidence in certain families.
Other influences on the development of this condition include -
Factors aggravating the disease include:
A critical part of the development of spondylosis is dehydration of the cervical tissues as part of the ageing process. Intervertebral discs may shrink and this allows increased bone-on-bone contact between adjacent vertebrae and the abnormal abrasion leads to both increased osteoclast activity and subsequent aberrations in bone growth. Similarly connective tissue ligaments may stiffen with dehydration. This makes the neck less flexible and calcification may develop. In the aberrant healing processes bony exostoses grow and can impact directly on nerves or the spinal cord with local inflammation and, in the long run, neural degeneration .
Lifestyle choices are important to ensure that ageing is not premature. Dietary, water intake and exercise practices should all be effective to reduce the impact of advancing age. Work condition or leisure activities that lead to neck injuries should be avoided.
Supporting pillows for good sleep posture.
The genetic component of the condition suggests that the offspring of affected parents are more likely to develop the condition, so special attention should be given to these potential sufferers. It might be unwise for couples with a history of severe disease in both families to have children.
Cervical spondylosis results from chronic wear and tear of the spine with deterioration of both the vertebrae and intervertebral discs. There is frequently abnormal growth of the vertebrae forming spurs. These changes lead to compression on one or more nerve roots and, in severe cases, the spinal cord can be affected. Presenting signs are related to the particular nerves involved and the severity of the lesions .
Cause: Although there is a genetic component to this condition as it is more prominent in some families, the usual causes are ageing and a history of neck injury from an accident or from work or play related activities.
Symptoms: This condition develops slowly and may first be identified through reduced mobility and stiffness of the neck. Recurring headaches, usually at the back of the head are an early sign. Patients with more severe cases may show abnormal sensation or numbness of the arms and hands, sometimes progressing to muscle weakness. Rarely there is a more severe paralysis or, in the very severe forms, urinary and bowel incontinence or paraplegia.
Diagnosis: The essence of diagnosis is good clinical examination supported by the clinical history. Radiography and MRI scans will provide supporting evidence to confirm a diagnosis. EMG and nerve conduction velocity tests can be used to identify nerve root activity.
Treatment: Collars can be used to prevent movement of the neck, along with physical therapy.
Prevention: Although ageing increases the likelihood of its development, lifestyle choices are important to prevent this condition. Work or leisure activities that lead to neck injuries are liable to increase the incidence of the disease.
The genetic component suggests that the offspring of affected parents are more likely to develop the condition, so this is another area of prevention that should be carefully pondered on with the partner.
Supporting pillows for good sleep posture and careful attention to diet and rehydration activities are likely to slow down the ageing processes.