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Cervical Spondylosis

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 [1].

Cervical spondylosis is also known as cervical osteoarthritis, neck arthritis and chronic neck pain.


Presentation

Prominent presenting signs are:

  • Stiff neck (with deterioration over time) 
  • Constant or recurring headaches (notably in the back of the head where cervical muscle attach)
  • Abnormal sensations or numbness

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.

More unusually there can be loss of balance or loss of bladder and bowel control when there is spinal cord involvement.

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 [7].

Arm Pain
  • ACDA is associated with a statistically but not clinically significant improvement in Arm pain VAS and SF-36 physical component summary.[ncbi.nlm.nih.gov]
  • Surgery can sometimes be useful for radiating arm pain due to cervical spondylosis, but it does not benefit neck pain.[hse.ie]
  • No significant differences were identified between the two groups regarding hospital stay, the Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) scores for neck and arm pain, total cervical range of motion (ROM), fusion ROM, fusion[ncbi.nlm.nih.gov]
  • You may experience: Neck pain Constant deep ache that radiates over the shoulder and down to the arms, hands and fingers numbness or weakness of the arms, hands, fingers or legs Muscles spasm, neck stiffness Headache Neck and arm pain can be caused by[nni.com.sg]
Fecal Incontinence
  • This condition may lead to the following: Inability to hold in feces ( fecal incontinence ) or urine ( urinary incontinence ) Loss of muscle function or feeling Permanent disability (occasionally) Poor balance Call your provider if: The condition becomes[nlm.nih.gov]
  • Possible Complications This condition may lead to the following: Inability to hold in feces ( fecal incontinence ) or urine ( urinary incontinence ) Loss of muscle function or feeling Permanent disability (occasionally) Poor balance When to Contact a[ufhealth.org]
Neck Pain
  • Secondary outcome measures include quality of life, adverse events, and relapse of neck pain. If successful, this project will provide evidence of the efficacy and safety of acupuncture for neck pain caused by cervical spondylosis.[ncbi.nlm.nih.gov]
  • Neck pain is one of the chief symptoms of cervical spondylosis (CS). Acupuncture is a well-accepted and widely used complementary therapy for the management of neck pain caused by CS.[ncbi.nlm.nih.gov]
  • Neck pain caused by cervical spondylosis (CS) has become one of the most common health problems around the world. Electroacupuncture (EA) has been employed to relieve CS neck pain, but there is limited clinical evidence for its effectiveness.[ncbi.nlm.nih.gov]
  • Patients with smaller cervical vertebral bodies are prone to persistent axial neck pain, but not neurological symptoms.[ncbi.nlm.nih.gov]
  • The results of this study demonstrated that PNMES is more effective than Sham PNMES for neck pain relief in patients with CS.[ncbi.nlm.nih.gov]
Shoulder Pain
  • The VAS score of preoperative neck and shoulder pain was (6.57 1.34) scores, which decreased to 1.80 0.65 at 1-week postsurgery, and was completely alleviated by the end of 1 month (VAS score 0-2 after 1, 3, and 6 mo after surgery) (Kruskal-Wallis rank-sum[ncbi.nlm.nih.gov]
  • If they perform it systematically, gains strong and flexible spine and make the sufferer free from neck pain, shoulder pain and cervical spondylosis.[gyanunlimited.com]
  • When symptoms develop, they are typically neck pain, stiffness, and sometimes scapular and shoulder pain. When the spondylosis causes spinal nerve root or spinal cord compression, this is a more serious condition.[emoryhealthcare.org]
  • Neck type: The main symptoms are the abnormal feeling of head, neck and shoulder pain, accompanied by corresponding pressure points. It is characterized by neck stiffness, pain, and activity inflexible of neck, it is also the most common type. 2.[ift.edu.mo]
Cervical Osteoarthritis
  • You don’t hear the term a lot because most people refer to it as either cervical osteoarthritis or neck arthritis. The condition impacts more than 85 percent of people over the age of 60.[belmarrahealth.com]
  • Also known as cervical osteoarthritis, this condition usually appears in men and women older than 40 and progresses with age. Although cervical spondylosis affects both sexes equally, men usually develop it at an earlier age than women do.[floridahospital.com]
  • Cervical spondylosis is also called cervical osteoarthritis . It is a condition involving changes to the bones, discs, and joints of the neck. These changes are caused by the normal wear-and-tear of aging.[webmd.com]
  • See Cervical Osteoarthritis (Neck Arthritis) Factors That Lead to Cervical Spondylosis with Myelopathy Factors that are thought to contribute to development of cervical spondylosis with myelopathy include: Normal age-dependent changes of the intervertebral[spine-health.com]
Spine Pain
  • Pain and stiffness are both episodic and usually varies with time (days and weeks). 2 The patient's pain and stiffness will generally present at the end of the day and espcially when the head is held in a specific position(usually in extension).[morphopedics.wikidot.com]
Neck Weakness
  • Symptoms Symptoms of cervical spondylosis can include: Pain in the neck that may travel to your arms or shoulders Headaches A grinding feeling when you move your neck Weakness in your arms and legs Numbness in your shoulders, arms, or hands Stiffness[hopkinsmedicine.org]
Headache
  • Background A considerable number of patients with cervical spondylosis complain about one or multiple atypical symptoms such as vertigo, palpitations, headache, blurred vision, hypomnesia, and/or nausea.[ncbi.nlm.nih.gov]
  • Atypical symptoms involved in the questionnaire included dizziness, headache, nausea, vomiting, blurred vision, tinnitus, palpitations, hypomnesia, and abdominal discomfort.[ncbi.nlm.nih.gov]
  • Patients with cervical spondylosis often present with some atypical symptoms such as vertigo, headache, palpitation, nausea, abdominal discomfort, tinnitus and blurred vision and hypomnesia.[ncbi.nlm.nih.gov]
  • […] total disk replacement (TDR), anterior cervical discectomy and fusion (ACDF), and laminoplasty on atypical symptoms of cervical spondylosis.Patients with confirmed diagnosis of cervical spondylosis and reported atypical symptoms such as blurred vision, headache[ncbi.nlm.nih.gov]
  • Muscles may be tense and in spasm and headaches may be prevalent if the upper neck is affected. Self Management Avoidance of aggravating activities and attending to correct posture at all times is often essential.[ssmc.com.au]
Cervical Radiculopathy
  • At the other extreme, cervical spondylosis may compress one or more of the spinal nerves branching out of the cervical vertebrae — a condition called cervical radiculopathy.[floridahospital.com]
  • Involvement of a nerve leading to pain and other symptoms in the upper limb is called cervical radiculopathy .[boneandspine.com]
  • See a doctor if you suspect that you are developing cervical radiculopathy or cervical myelopathy.[patient.info]
  • Treatment and prognosis of cervical radiculopathy. . Accessed May 8, 2018. Shelerud RA (expert opinion). Mayo Clinic, Rochester, Minn. May 10, 2018.[mayoclinic.org]
Neck Stiffness
  • Physical examination reveals neck stiffness and numbness in the affected root. Lab Studies Laboratory values are mostly normal in cervical spondylosis.[boneandspine.com]
  • Typical symptoms include dull ache, neck stiffness, grinding and popping sounds with neck movement, and increased pain with looking to the sides especially during activities such as driving.[rapaindocs.com]
  • It is characterized by neck stiffness, pain, and activity inflexible of neck, it is also the most common type. 2.[ift.edu.mo]
  • Other common symptoms include: Neck stiffness that gets worse over time Numbness or abnormal sensations in the shoulders, arms or (rarely) legs Headaches, especially in the back of the head Reduced reflexes Loss of balance Loss of control over the bladder[neuro.memorialhermann.org]
  • Symptoms In case of cervical spondylosis, the classic signs of osteoarthritis are found with: a progressive destruction of joint cartilage in the vertebrae close to the head and neck; discomfort and pain in the neck; neck stiffness with reduced mobility[health.ccm.net]
Hyperreflexia
  • Eleven patients (58%) had lower limb hyperreflexia or Babinski sign.[ncbi.nlm.nih.gov]
  • In an otherwise asymptomatic patient, hyperreflexia, a positive Babinski test, and a positive Hoffman’s sign (hand contraction in response to tapping on distal finger joints) are early signs of cervical spondylosis.[americannursetoday.com]
  • A characteristic physical finding of CSM is hyperreflexia. The biceps and supinator reflexes (C5 and C6) may be absent, with a brisk triceps reflex (C7).[aafp.org]
Clonus
  • On physical examination, you may find some or many of the following: clonus or spasticity of the lower extremities sensory changes (light touch, pinprick sensation, or temperature dysfunction) generalized weakness throughout muscle groups, especially[americannursetoday.com]
  • In more than 70% of the cases, the reflexes are hyperactive at a varying distance below the level of cervical spinal canal stenosis; clonus or Babinski’s reflex may also be present.[termedia.pl]
  • A positive Hoffman's sign (flexion of the terminal phalanx of the thumb and second and third phalanges of the other fingers when one of the middle fingertips is flicked) and ankle clonus are also common findings.[ncbi.nlm.nih.gov]
  • This pattern is almost pathognomonic of cord compression because of cervical spondylosis at the C5-C6 interspace. 12 Ankle clonus and Babinski's sign (pathologic extension of the great toe elicited by stroking the foot) in the feet may also be revealed[aafp.org]
Urinary Incontinence
  • This condition may lead to the following: Inability to hold in feces ( fecal incontinence ) or urine ( urinary incontinence ) Loss of muscle function or feeling Permanent disability (occasionally) Poor balance Call your provider if: The condition becomes[nlm.nih.gov]
  • Possible Complications This condition may lead to the following: Inability to hold in feces ( fecal incontinence ) or urine ( urinary incontinence ) Loss of muscle function or feeling Permanent disability (occasionally) Poor balance When to Contact a[ufhealth.org]
  • Complications associated with Cervical Spondylosis include: Loss of bladder/bowel function (urinary incontinence) Functional impairment (clumsiness, sense of fine motor skills and coordination may be impaired) Loss of muscle function In rare cases, permanent[dovemed.com]
  • Symptoms can include: a lack of co-ordination, for example you may find tasks such as buttoning a shirt increasingly difficult heaviness or weakness in your arms or legs problems walking less commonly, urinary incontinence (loss of bladder control) bowel[your.md]

Workup

A complete physical examination - this should identify limitations to head and neck mobility in all directions as well as locating specific areas of discomfort or weakness.

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 [8].

Electromyography (EMG) and nerve conduction velocity tests can provide information on the activity of nerve roots.

Treatment

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:

  • non-steroidal anti-inflammatory drugs (NSAIDs) for long-term control
  • narcotics are sometimes used for severe pain that is non-responsive to NSAIDs.

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 [9].

Prognosis

Cervical spondylosis usually gives some long-term symptoms. In most cases, these are ameliorated by physical or medical therapy and surgery is not required.

Although permanent disability with loss of muscle function or sensation does occasionally occur, complications such as urinary or faecal incontinence and poor balance are very unlikely.

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 [6].

Etiology

Although everyday wear-and-tear may initiate changes, there is frequently an underlying history of excessive trauma of the neck due to work or lifestyle activities. There is also a genetic component in the manifestation of this condition [3].

Epidemiology

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:

  • Lengthy sitting or standing 
  • Moving the head
  • Walking
  • Sudden movements – e.g. sneezing, laughing, coughing.
Sex distribution
Age distribution

Pathophysiology

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 [5].

Prevention

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[10].

Summary

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 [2].

Patient Information

Definition: A chronic painful condition of the neck in which deterioration changes of the cervical vertebrae impinge on the nerves running close to them and, sometimes, the spinal cord.

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.

References

Article

  1. Tsiptsios I, Fotiou F, Sitzoglou K, et al. Neurophysiological investigation of cervical spondylosis.Electromyogr Clin Neurophysiol. Jul-Aug 2001;41(5):305-13.
  2. Binder AI. Cervical spondylosis and neck pain. BMJ. Mar 10 2007;334(7592):527-31.
  3. Jumah KB, Nyame PK. Relationship between load carrying on the head and cervical spondylosis in Ghanaians. West Afr J Med. Jul-Sep 1994;13(3):181-2.
  4. Nurick S. The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain. 1972;95(1):87-100.
  5. Ramzi N, Ribeiro-Vaz G, Fomekong E, et al. Long term outcome of anterior cervical discectomy and fusion using coral grafts. Acta Neurochir (Wien). Dec 2008;150(12):1249-56; discussion 1256.
  6. Hoff JT, Panadopoulos SM. Cervical disc disease and cervical spondylosis. In: Wilkins RH, Rengachary SS, eds. Neurosurgery. New York, NY: McGraw-Hill; 1996:3756-74.
  7. Banaszek A, Bladowska J, Szewczyk P, Podgòeski P, Sasiadek M. Usefulness of diffusion tensor MR imaging in the assessment of intramedullary changes of the cervical spinal cord in different stages of degenerative spine disease. Eur Spine J. Jul 2014;23(7):1523-30.
  8. Fouyas IP, Statham PF. Operative treatment of cervical spondylosis. Br J Neurosurg. Dec 1998;12(6):594-5.
  9. Sari-Kouzel H, Cooper R. Managing pain from cervical spondylosis. Practitioner. Apr 1999;243(1597):334-8.
  10. Ozer AF, Oktenoglu T, Cosar M, et al. Long-term follow-up after open-window corpectomy in patients with advanced cervical spondylosis and/or ossification of the posterior longitudinal ligament. J Spinal Disord Tech. Feb 2009;22(1):14-20.

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Last updated: 2018-06-22 03:36