Cervical Spondylosis

What is it: Age related progressive degeneration of the cervical spine, inclusive of disc degeneration, facet arthropathy, osteophyte formation, ligamentous thickening and loss of cervical lordosis. Narrowing of the spinal canal, also known as spinal stenosis may develop as a result of the spondylitic changes. The spinal cord and/or nerve root functions may be be negatively affected, resulting in symptoms of myelopathy or radiculopathy.

Incidence: age >40
Most common cause for myelopathy in persons over 55yrs
85% of people over the age of 60 years have some degree of disc degeneration.
Male> females

Risk factors

Ageing
Repetitive strain injury
Genetics
Smoking
Occupation
Depression/ anxiety
Injuries/ trauma

Pathology: As the spine ages (or due to trauma) the discs between the vertebrae dessicate and become thinner. The ligaments may become thinner, the ligaments may become tight, causing the joints above or below the affected joint to become hyper mobile. The body reacts by generating the osteophytes (bone spurs) to try to stabilise the spine.


Age related degeneration and dehydration of intervertebral discs.
 Decreased cartilage between adjacent vertebral bodies.
Development laxity in the spinal supportive ligaments.
Hyper-mobility of spinal segments.
Bone on bone apposition propagates bone spur formation which narrow the cervical spinal canal and may compress the cervical nerve roots and spinal cord.

Clinical Features:
Pain
Stiffness
progressively worsens
Muscle spasm
Pop and crack

Neurologic
Nerve root compression: Cervical radiculopathy pain (subscapular to finger tips).
Spinal cord compression: Cervical myelopathy, dizziness, loss of bladder control, loss of bowel control, numbness of legs.


Dynamic factors relate to the fact that normal flexion and extension of the cord may aggravate spinal cord damage initiated by static compression of the cord. During flexion, the spinal cord lengthens, resulting in it being stretched over ventral osteophytic bars. During extension the ligamentum flavum may buckle into the cord, pinching the cord between the ligaments and the anterior osteophytes.

Cervical radiculopathy



A sharp dull pain that travels from your shoulder down one of the arms to the fingertips
Numbness, pins and needles in the affected arm and stretching the neck or turning the head makes pain worse.
This pain is caused by the nerve roots being compressed by osteophytes or disc materials.

Cervical Myelopathy





Cervical myelopathy occurs when severe cervical spondylosis causes narrowing of the spinal canal (also known as stenosis) and compression of the spinal cord. When the spinal cord is compressed, it interferes with the signals that travels between your brain and the rest of your body







Screening and diagnosis

Flexibility test of the neck by having bend the head to the should and turn the head from side to side.
Nerve function test: Check for neurological changes due to compression of the spine by testing the reflexes and seeing how the nerves and muscles in the arms and legs function. Walking watch to determine whether spinal compression is affecting the gait

Neck/ spinal Xray- show abnormalities- bone spurs, that  indicate cervical spondylosis

Other tests: CT scan or MRI
Myelogram
                   











Treatment

Without treatment, the signs and symptoms of cervical spondylosis may decrease or stabilise, or they may worsen.

The goal of treatment is to relieve pain and prevent permanent injury to the spinal cord and nerves.


- Wear a neck brace (cervical collar) during the day to help limit neck motion and reduce nerve irritation. Only used for short periods of time coz long periods can decrease the strength of neck muscles.
- NSAIDS- Ibuprofen (Advil, Motrin)
-Physiotherapy to strengthen the neck muscles and stretch the neck and shoulders. Low impact aerobic exercise= walking or water aerobics.


Hospitalisation with bed rest and traction on the neck for a week or two to completely immobilise the cervical spine and reduce the pressure on spinal nerves.

Taking muscle relaxants- methocarbamol (Roxabin) or cyclobenzaprine (Flexeril), particularly if neck muscle spasms occur and taking narcotic medication to relieve severe pain.

Injecting corticosteroid medications into the joints between the vertebrae (facet joints). The injection combines corticosteroid mediation with local anaesthetic to reduce pain and inflammation

Environmental Changes
- Proper lifting technique
- Wear soft collar to restrict unwanted movements
- Avoiding prolonged sitting or standing and selecting the proper chair
Workplace modifications and ergonomics serve to reduce strenuous neck positions during work and leisure

SURGERY
In patient with severe pain not relieved by any other treatment.
Laminectomy