Cervical spondylosis is a common, age-related condition that affects the joints and discs in your cervical spine, which is in your neck. It is also known as cervical osteoarthritis or neck arthritis.
It develops from the wear and tear of cartilage and bones. While it’s largely the result of age, it can be caused by other factors as well. Cervical spondylosis is very common and worsens with age. More than 85 percent of people older than age 60 are affected by cervical spondylosis.
Some people who have it never experience symptoms. For others, it can cause chronic, severe pain and stiffness. However, many people who have it are able to conduct normal daily activities.
Symptoms of Cervical Spondylosis :
Most people with cervical spondylosis don’t have significant symptoms. If symptoms do occur, they can range from mild to severe and may develop gradually or occur suddenly.
One common symptom is pain around the shoulder blade. Some complaint of pain along the arm and in the fingers. The pain might increase when:
- Tilting the neck backward
Another common symptom is muscle weakness. Muscle weakness makes it hard to lift the arms or grasp objects firmly.
Other common signs include :
- A stiff neck that becomes worse
- headaches that mostly occur in the back of the head
- tingling or numbness that mainly affects the shoulders and arms, although it can also occur in the legs
Symptoms that occur less frequently often include a loss of balance and a loss of bladder or bowel control. These symptoms warrant immediate medical attention.
Cervical Spondylosis Causes :
The bones and protective cartilage in the neck are prone to wear and tear that can lead to cervical spondylosis. Possible causes of the condition include:
- Dehydrated discs:- Discs act as cushions between the vertebrae of the spine. By the age of 40, most people’s spinal discs begin drying out and shrinking, which allows more bone-on-bone contact between the vertebrae.
- Herniated discs:- Age also affects the exterior of your spinal discs. Cracks often appear, leading to bulging (herniated) discs — which sometimes can press on the spinal cord and nerve roots.
- Bone spurs:- Disc degeneration often results in the spine producing extra amounts of bone in a misguided effort to strengthen the spine. These bone spurs can sometimes pinch the spinal cord and nerve roots.
- Stiff ligaments:- Ligaments are cords of tissue that connect bone to bone. Spinal ligaments can stiffen with age, making the neck less flexible.
Risk Factors :
The greatest risk factor for cervical spondylosis is aging. Cervical spondylosis often develops as a result of changes in the neck joints with age. Disc herniation, dehydration and bone spurs are all results of aging.
Factors other than aging can increase your risk of cervical spondylosis. These include:
- Jobs that involve repetitive neck motions, awkward positioning or a lot of overhead work put extra stress on the neck.
- Previous neck injuries appear to increase the risk of cervical spondylosis.
- Some individuals in certain families will experience more of these changes over time, while others will not.
- Smoking has been linked to increased neck pain.
The following diagnostic tests may be advised to confirm the diagnosis of cervical spondylosis:
- Neck X-ray:- An X-ray can show abnormalities, such as bone spurs, that indicate cervical spondylosis. Neck X-ray can also rule out rare and more serious causes for neck pain and stiffness, such as tumors, infections or fractures.
- CT scan:- A CT scan can provide more detailed imaging, particularly of bones.
- MRI Scan:- MRI can help pinpoint areas where nerves might be pinched.
- Tracer Dye:- A tracer dye is injected into the spinal canal to provide more detailed X-ray or CT imaging.
- Nerve function tests:- It is usually advised to determine if nerve signals are traveling properly to the muscles. This test measures the electrical activity in the nerves as they transmit messages to the muscles when the muscles are contracting and at rest.
- Nerve conduction study:- Electrodes are attached to the skin above the nerve to be studied. A small shock is passed through the nerve to measure the strength and speed of nerve signals.
Treatment of Cervical Spondylosis
#Non-surgical treatment :
In most cases, treatment for cervical spondylosis is nonsurgical. Nonsurgical treatment options include:
1). Physical therapy:- Physical therapy is usually the first nonsurgical line of treatment. Specific exercises can help relieve pain, as well as strengthen and stretch weakened or strained muscles. In some cases, physical therapy may include posture therapy or the use of traction to gently stretch the joints and muscles of the neck. Physical therapy programs vary in length but generally last from 6 to 8 weeks. Typically, sessions are scheduled 2 to 3 times per week.
2). Medications:- During the first phase of treatment, several medications may be prescribed to be used together to address both pain and inflammation. Mild pain is often relieved with acetaminophen.
- Nonsteroidal anti-inflammatory drugs (NSAIDs):- Often prescribed with acetaminophen, NSAIDs such as ibuprofen and naproxen are considered first-line medications for neck pain. They relieve both pain and swelling and may be prescribed for a number of weeks, depending on the specific symptoms. Other types of pain medication can be considered if there are serious contraindications to NSAIDs or if the pain is not well controlled.
- Muscle relaxants:- Medications such as cyclobenzaprine or carisoprodol can be used to treat painful muscle spasms.
3). Soft cervical collar:- This is a padded ring that wraps around the neck and is held in place with velcro. It may be advised to limit neck motion and allow the muscles in the neck to rest. A soft collar should only be worn for a short period of time since long-term wear may decrease the strength of the muscles in the neck.
4). Ice, heat, and other modalities:- Careful use of ice, heat, massage, and other local therapies may be recommended to help relieve symptoms.
5). Steroid-based injections:- Many patients find short-term pain relief from steroid injections. The most common procedures for neck pain include:
6). Cervical epidural block:- In this procedure, steroid and anesthetic medicine is injected into space next to the covering of the spinal cord (“epidural” space). This procedure is typically used for neck and/or arm pain that may be due to a cervical disk herniation, also known as radiculopathy or a “pinched nerve.”
7). Cervical facet joint block:- In this procedure, steroid and anesthetic medicine is injected into the capsule of the facet joint. The facet joints are located in the back of the neck and provide stability and movement. These joints can develop arthritic changes that may contribute to neck pain.
8). Medial branch block and radiofrequency ablation:- This procedure is used in some cases of chronic neck pain. It can be used to both diagnose and treat a painful joint. During the diagnosis portion of the procedure, the nerve that supplies the facet joint is blocked with a local anesthetic. If the pain is relieved, then the source of your neck pain may have been pinpointed. The next step option may be to block the pain more permanently. This is done by damaging the nerves that supply the joint with a “burning” technique—a procedure called radiofrequency ablation.
# Surgical treatment of Cervical Spondylosis :
Surgery is not commonly recommended for cervical spondylosis and neck pain unless it is determined that:
- A spinal nerve is being pinched by a herniated disk or bone (cervical radiculopathy), or
- The spinal cord is being compressed (cervical spondylotic myelopathy).
The surgery might involve:
- Removing a herniated disk or bone spurs
- Removing part of a vertebra
- Fusing a segment of the neck using bone graft and hardware
Patients who have progressive neurologic symptoms, such as arm weakness, numbness, or falling, are more likely to be helped by surgery.
Surgery may also be recommended if there is severe pain that has not been relieved by nonsurgical treatment. However, some patients with severe neck pain will not be candidates for surgery. This may be due to the widespread nature of their arthritis, other medical problems, or other causes for their pain, such as fibromyalgia.