Cervical spondylosis – Causes, symptoms, diagnosis, Treatment

Cervical spondylosis is a general term for age-related wear and tear affecting the joints in your neck. 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.

As you age, the bones and cartilage that make up your backbone and neck gradually deteriorate, sometimes forming irregular bony outgrowths called bone spurs. These changes, which are characteristic of cervical spondylosis, occur in everyone’s spine. Still, many people with signs of cervical spondylosis on X-rays manage to escape the associated symptoms, which include pain, stiffness and muscle spasms.

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. Bone spurs and other irregularities caused by cervical spondylosis also may reduce the diameter of the canal that houses the spinal cord, resulting in cervical myelopathy. Cervical radiculopathy and cervical myelopathy can lead to permanent disability. Fortunately, most adults with cervical spondylosis — nearly 90 percent — will not lose nerve function, even temporarily.

Causes

Age-related wear and tear is probably the basic cause of cervical spondylosis. By age 30, many people show signs of vertebral and disk degeneration on X-ray, although symptoms don’t appear until later in life. Specific changes occurring with age include:

  • Drying and loss of elasticity in the spinal and cervical disks
  • Bulging and sometimes herniation of disks so that disk material protrudes from between two vertebrae
  • Stiffening of the ligaments connecting neck bones and muscles

Aging and wear and tear on your spine are the major risk factors for cervical spondylosis. You may be more likely to develop cervical spondylosis if you’ve had a neck injury.

Symptoms

The signs and symptoms of cervical spondylosis are:

  • A stiff, painful neck
  • Shoulder, arm or chest pain
  • Tingling and pinprick sensations in the arms, hands, legs or feet
  • Numbness and weakness in the arms, hands, legs or feet
  • Lack of coordination
  • Difficulty walking
  • Abnormal reflexes
  • Loss of bladder or bowel control, or urinary or bowel retention

Diagnosis

Your symptoms and history, along with an examination, may suggest that you have cervical spondylosis. You may also have imaging tests. The workup may include:

  • Neck flexibility assessment. Cervical spondylosis limits the range of motion in your neck. To observe this effect, your doctor may have you tilt your head toward each of your shoulders and rotate your neck from side to side.
  • Neurological exam. To find out if there’s pressure on your spinal nerves or spinal cord, your doctor will test your reflexes and make sure you have sensation all along your arms and legs. He or she may watch you walk to see if spinal compression is affecting your gait.
  • Neck or spinal X-ray. An X-ray may show abnormalities, such as bone spurs, that indicate cervical spondylosis.
  • Computerized tomography (CT) scan or magnetic resonance imaging (MRI). A CT scan of your spine uses X-ray technology, but produces a more detailed image than X-ray can. MRI uses a magnetic field and radio waves and can produce detailed, cross-sectional images of your spine. These tests may help your doctor determine the extent of damage to your cervical spine.
  • Myelogram. This test involves generating images using X-rays or CT scans after dye is injected into the spinal canal. The dye makes areas of your spine more visible.

Treatment

Without treatment, the signs and symptoms of cervical spondylosis may decrease or stabilize, or they may worsen. The goal of treatment is to relieve pain and prevent permanent injury to the spinal cord and nerves.

Treatment of mild cases

Mild cases of cervical spondylosis may respond to:

  • Wearing a neck brace (cervical collar) during the day to help limit neck motion and reduce nerve irritation.
  • Taking nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil, Motrin, others) for pain relief.
  • Doing exercises prescribed by a physical therapist to strengthen neck muscles and stretch the neck and shoulders. Low-impact aerobic exercise, such as walking or water aerobics, also may help.

Treatment of more serious cases
For more severe cases, nonsurgical treatment may include:

  • Hospitalization with bed rest and traction on the neck for a week or two to completely immobilize the cervical spine and reduce the pressure on spinal nerves.
  • Taking muscle relaxants, such as methocarbamol (Robaxin) or cyclobenzaprine (Flexeril), particularly if neck muscle spasms occur.
  • Injecting corticosteroid medications into the joints between the vertebrae (facet joints). The injection combines corticosteroid medication with local anesthetic to reduce pain and inflammation.

Surgery
If conservative treatment fails or if your neurological signs and symptoms, such as weakness in your arms or legs, are getting worse, you may need surgery. The surgical procedure will depend on your underlying condition, such as bone spurs or spinal stenosis. The most common surgical options include:

  • Frontal approach (anterior). Your surgeon makes an incision in the front of your neck and moves aside the windpipe (trachea) and swallowing tube (esophagus) to expose the cervical spine. Your surgeon can then remove a herniated disk or bone spurs, depending on the underlying problem. Sometimes, with disk removal, your surgeon will fill the gap with a graft of bone or other implant.With the anterior approach, your surgeon can relieve pressure on your spinal cord from bone or from multiple disk protrusions by removing two disks and the bone between them (corpectomy). Then, to support your head and neck, your surgeon reconstructs the area with bone from your body or a bone bank or with an implant made of metal combined with bone.
  • Back approach (posterior). Your surgeon may opt to remove or rearrange bone from the back of your neck, especially if several portions of the channel that houses the cord have narrowed. The operation, called a laminectomy, removes the back part of the bone over the spinal canal through an incision in the back of your neck.Laminoplasty, an alternative to laminectomy, involves cutting and moving pieces of vertebrae to make more room for the spinal cord. Although laminoplasty takes longer, it is less likely to leave the neck unstable.

Risks of surgery
Risks of these procedures include infection, a tear in the membrane that covers the spinal cord at the site of the surgery, bleeding, a blood clot in a leg vein and neurological deterioration. In addition, the surgery may not eliminate all the problems associated with your condition.

Cervical spondylosis is the most common cause of spinal cord dysfunction in older adults. Any compression of the spinal cord requires prompt surgical treatment to avoid permanent disability.

Prevention

You may not be able to prevent cervical spondylosis. However, you may be able to reduce your risk by:

  • Skipping high-impact activities, such as running, if you have any neck pain
  • Doing exercises to maintain neck strength, flexibility and range of motion
  • Taking breaks when driving, watching TV or working on a computer to keep from holding your head in the same position for long periods
  • Practicing good posture, with your neck aligned over your shoulders
  • Protecting your neck from injury by using a seat belt when in a car