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Cervical Spondylosis

Also known as cervical osteoarthritis, it is a degenerative disorder in which there is abnormal wear and tear of the cartilage and bones of the neck (cervical vertebrae).It is one of the common causes of neck pain.


Symptoms

Symptoms of cervical spondylosis pain around the neck and shoulder. The pain can be severe in some cases. Occasional headaches may also occur, which usually start at the back of the head, just above the neck, and travel over the top to the forehead. Pain usually comes and goes, with flare-ups followed by symptom-free periods.


Symptoms usually only occur if you develop:


Cervical radiculopathy – where a slipped disc or other bone pinches or irritates a nearby nerve

Cervical myelopathy – where the spinal canal (bones that surround and protect the nerves) becomes narrower, compressing the spinal cord inside.


The details of these conditions are given below:

Cervical radiculopathy

The most common symptom of cervical radiculopathy is a sharp pain that "travels" down one of your arms (also known as brachialgia). You may also experience some numbness or "pins and needles" in the affected arm, and find that stretching your neck and turning your head makes the pain worse.


Cervical myelopathy

Cervical myelopathy occurs when severe cervical spondylosis causes narrowing of the spinal canal and compression of the spinal cord. When the spinal cord is compressed, it interferes with the signals that travel between your brain and the rest of your body.

 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 incontinence (loss of bowel control)

Left untreated, cervical myelopathy can lead to permanent spinal cord damage and long-term disability.


Causes


The bones and cartilage that make up your spine gradually develop wear and tear. These changes can include:

  • Dehydrated disks. Disks act like cushions between the vertebrae of your spine. After the age of 40 spinal disks begin drying out and shrinking, which allows more bone-on-bone contact between the vertebrae leading to wear and tear.
  • Herniated disks. Age also affects the exterior of your spinal disks. Cracks often appear, leading to bulging (herniated) disks — which sometimes can press on the spinal cord and nerve roots.
  • Bone spurs. Disk 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 and cause severe pain.
  • Stiff ligaments.  Spinal ligaments may stiffen with age making the neck less flexible and predisposing to degeneration.


Risk factors:

The major risk factor is aging. Other factors that can make a person more likely to develop spondylosis are:


  • Age. Cervical spondylosis is a normal part of aging.
  • Being overweight and not exercising
  • Occupation Having a job that requires heavy lifting or a lot of bending and twisting
  • Ruptured or slipped disk
  • Past neck injury (often several years before)
  • Past spine surgery
  • Small fractures to the spine from osteoporosis
  • Genetic factors. Some individuals in certain families will experience more of these changes over time, while others will not.
  • Smoking. Smoking has been linked to increased neck pain

It’s worth mentioning that apart from the above mentioned Improper Spinal Posture is most important factor in occurrence of cervical spondylosis.
When your neck posture is optimum the weight / stress is carried out with proper bio-mechanics however if the posture is abnormal (spinal posture will be discussed in a separate section)

How Is Cervical Spondylosis Diagnosed?


Cervical spondylosis is usually suspected if there are typical symptoms of neck pain and stiffness. It will also be considered as a cause of radiating arm pain, problems with use of the hands or difficulty walking.

Physical examination

The doctor / physiotherapist will generally begin by asking you about symptoms and taking a medical history. This will be followed by a physical exam of the body, with a focus on the neck, back, and shoulders. The therapist also tests reflexes and the strength of hands and arms, check for loss of sensation, and watch you walk.


X-rays. These provide images of dense structures, such as bone. An x-ray will show the alignment of the bones along your neck. It can also reveal degenerative changes in your cervical spine—such as the loss of disk height or the presence of bone spurs.


Magnetic resonance imaging (MRI) scans. These studies create better images of the body's soft tissues, such as muscles, disks, nerves, and the spinal cord. An MRI can help determine whether your symptoms are caused by damage to soft tissues—such as a bulging or herniated disk.


Computed tomography (CT) scans. More detailed than a plain x-ray, a CT scan can help your physician better view your spinal canal and any bone spurs.


Myelogram This is a special type of CT scan. In this procedure, a contrast dye is injected into the spinal canal to make the spinal cord and nerve roots show up more clearly.


Electromyography (EMG). Electromyography measures the electrical impulses of the muscles at rest and during contractions. Nerve conduction studies are often done along with EMG to determine if a spinal nerve is functioning properly.


Other tests. In some cases, your physician may order a blood test to determine whether a rheumatoid factor—or any other antibody indicative of inflammatory arthritis--is present.

Treatment


Nonsurgical Treatment

In most cases, treatment for cervical spondylosis is nonsurgical. Nonsurgical treatment options include:


Physiotherapy: Physiotherapy is usually the first nonsurgical treatment that is recommended. 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 your neck. Physical therapy programs vary in length, but generally last from 4 to 8 weeks. Typically, sessions are scheduled 3 to 4 times per week.


Medications During the first phase of treatment several medications may be used together to address both pain and inflammation.

  • Acetaminophen. Mild pain is often relieved with acetaminophen.
  • Non steroidal anti-inflammatory drugs (NSAIDs) often prescribed with acetaminophen; NSAIDs 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 your specific symptoms. Muscle relaxants. Medications can be used to treat painful muscle spasms.

Soft cervical collar This is a padded ring that wraps around the neck and is held in place with Velcro. Your doctor /physiotherapist may advise you to wear a soft cervical collar to limit neck motion and allow the muscles in your 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 your neck.


Ice, heat, and other modalities. Your doctor may recommend careful use of ice, heat, massage, and other local therapies to help relieve symptoms.


Surgery

Surgery is usually only recommended in the treatment of cervical spondylosis if:

  • There is clear evidence that a nerve is being pinched by a slipped disk or bone (cervical radiculopathy), or your spinal cord is being compressed (cervical myelopathy)
  • There is underlying damage to your nervous system that is likely to worsen if surgery is not performed
  • Surgery may also be recommended if you have persistent pain that fails to respond to other treatments.