Cervical spondylosis

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at May 25, 2016
StartDiseasesCervical spondylosis

Cervical spondylosis is a common cause of neck pain particularly for those over the age of 60. It results from the compression of the spine when intervertebral discs in the neck wear out. It is also known as cervical osteoarthritis

Contents

Definition & Facts 

Cervical spondylosis is an age-related condition of the spinal discs in the neck and results when these discs that cushion the bones begin to wear out and shrink. When the discs deteriorate, the bones rub against each other, causing pain.

Symptoms & Complaints 

In many cases, this form of spondylosis isn't severe enough to present with symptoms. As the condition progresses, the symptoms can come and go at first and then worsen as the discs continue to degenerate.

Individuals suffering with cervical spondylosis complain most often of neck and shoulder pain. Neck movement may be limited due to stiffness and pain at the base of the skull. Nerves can become pinched and send radiating pain down into the arms, lower back, and the legs, depending on the affected nerve. A "pins and needles" sensation may present in extremities if a nerve is pinched.

Facial pain can present under the eyes and, in rare occasions, along the jaw line. Headaches are also common with this condition. Muscle spasms can occur when the patient tries to minimize movement to avoid pain and when the nerve impulses don't reach certain muscle groups. In very severe cases, loss of bladder control may occur.

Causes

The base of the skull is connected to the cervical vertebrae. In between the bones, discs made of strong fiber and gel-like substance cushion the bones and prevent them from rubbing together. Cervical spondylosis occurs when these discs, due to wear and tear of the normal aging process or extraneous strain, begin to shrink or degenerate.

Bone spurs or bony projections can develop, which can cause pain and be severe enough to pinch the nerves running inside the spinal column. As the structure of the spine changes, the surrounding muscles, tendons that affect neck movement, and nerves are bumped or pressed and cause the pain and symptoms listed above.

There may be a genetic factor to cervical spondylosis. Other risk factors include work that involves lifting weight and straining, obesity, ruptured or slipped disc, spinal injury, neck injury, and sedentary lifestyle, osteoporosis, and arthritis.

Diagnosis & Tests 

Only a medical professional can diagnose spondylosis, as not all causes of neck or shoulder pain are attributable to cervical spondylosis. The physician will start with a general examination to test reflexes and sensation in the arms and legs and ask a series of questions about symptoms. 

X-rays show structural problems that occur after the cervical discs have deteriorated, like bone spurs. Imaging tests like MRIs can show detailed spinal changes and lead to a stronger diagnosis regarding nerve damage. A CT scan would take the place of an MRI if a patient has a pacemaker or metal implant that the MRI machine would adversely affect due its use of magnetic fields and powerful radio waves. CT scans take a series of X-rays and piece them together to form a detailed image. 

If nerve damage is suspected, a nerve conduction study may be ordered to assess the muscles and nerves in arms and legs and determine how severe the condition might be. Another imaging test is a myelogram. This test uses an X-ray paired with dye injected into the spine and can detect whether herniated discs are compressing the spine, spinal lesions, infection, and spinal stenosis.

Treatment & Therapy

Once cervical spondylosis is properly diagnosed, there are varying levels of treatment to consider. The physician will generally recommend a conservative or noninvasive approach first. It may be recommended to treat initial symptoms with simple stretches and either warm compresses or ice to the area.

Other nonsurgical treatments such as an over-the-counter anti-inflammatory like ibuprofen or a short course of steroids can help reduce inflammation in the muscles and relieve pain. Prescription drugs like muscle relaxants, antidepressants and some seizure medications may also be tried to help mitigate pain.

A series of visits to a physical therapist may be ordered. The therapist can demonstrate neck, shoulder and arm exercises and strengthening techniques to aid in healing and symptom control. Some may opt for alternative medicine therapies like acupuncture and chiropractic solutions instead of surgery.

If nerve damage or muscle weakness persists or worsens, a surgical intervention may be needed. During surgery, weakened or herniated discs may be removed or repaired, bone spurs could be removed and, in severe cases of advanced bone loss, hardware may be installed to give the spine the support it needs. 

Prevention & Prophylaxis 

Because the root cause of cervical spondylosis is wear and tear from aging, not all cases can be prevented. Proper neck posture with no slouching and proper lifting of heavy objects can help prevent damage to the cervical spine. Also, sleeping with the right thickness of pillow instead of too many or none at all provides support to the neck through the night. 

Walking, swimming and stretching with the proper posture can strengthen the muscles around the spine, allowing for more support. It is important to avoid sitting or standing in the same position for long periods of time, especially when working in front of a screen. One should also take time to stretch the neck in all directions to avoid stiffness and increase range of motion. 

Other healthy lifestyle choices like remaining tobacco-free, eating a healthy diet, weight management, and having a fitness routine will aid in overall muscle and bone health and can slow the onset of symptoms.