cervical spondylosis


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Cervical Spondylosis

 

Definition

Cervical spondylosis refers to common age-related changes in the area of the spine at the back of the neck. With age, the vertebrae (the component bones of the spine) gradually form bone spurs, and their shock-absorbing disks slowly shrink. These changes can alter the alignment and stability of the spine. They may go unnoticed, or they may produce problems related to pressure on the spine and associated nerves and blood vessels. This pressure can cause weakness, numbness, and pain in various areas of the body. In severe cases, walking and other activities may be compromised.

Description

As it runs from the brain down the back, the spinal cord is protected by ringlike bones, called vertebrae, stacked one upon the other. The vertebrae are not in direct contact with one another, however. The intervening spaces are filled with structures called disks. The disks are made up of a tough, fibrous outer tissue with an inner core of elastic or gel-like tissue.
One of the most important functions of disks is protecting the vertebrae and the nerves and blood vessels between the vertebrae. The disks also lend flexibility to the spinal cord, facilitating movements such as turning the head or bending the neck. As people age, disks gradually become tougher and more unyielding. Disks also shrink with age, which reduces the amount of padding between the vertebrae.
As the amount of padding shrinks, the spine loses stability. The vertebrae react by constructing osteophytes, commonly known as bone spurs. There are seven vertebrae in the neck; development of osteophytes on these bones is sometimes called cervical osteoarthritis. Osteophytes may help to stabilize the degenerating backbone and help protect the spinal cord.
By age 50, 25-50% of people develop cervical spondylosis; by 75 years of age, it is seen in at least 70% of people. Although shrunken vertebral disks, osteophyte growth, and other changes in their cervical spine may exist, many of these people never develop significant problems.
However, about 50% of people over age 50 experience neck pain and stiffness due to cervical spondylosis. Of these people, 25-40% have at least one episode of cervical radiculopathy, a condition that arises when osteophytes compress nerves between the vertebrae. Another potential problem occurs if osteophytes, degenerating disks, or shifting vertebrae narrow the spinal canal. This pressure compresses the spinal cord and its blood vessels, causing cervical spondylitic myelopathy, a disorder in which large segments of the spinal cord are damaged. This disorder affects fewer than 5% of people with cervical spondylosis. Symptoms of both cervical spondylitic myelopathy and cervical radiculopathy may be present in some people.

Causes and symptoms

As people age, shrinkage of the vertebral disks prompts the vertebrae to form osteophytes to stabilize the back bone. However, the position and alignment of the disks and vertebrae may shift despite the osteophytes. Symptoms may arise from problems with one or more disks or vertebrae.
Osteophyte formation and other changes do not necessarily lead to symptoms, but after age 50, half of the population experiences occasional neck pain and stiffness. As disks degenerate, the cervical spine becomes less stable, and the neck is more vulnerable to injuries, including muscle and ligament strains. Contact between the edges of the vertebrae can also cause pain. In some people, this pain may be referred—that is, perceived as occurring in the head, shoulders, or chest, rather than the neck. Other symptoms may include vertigo (a type of dizziness) or ringing in the ears.
The neck pain and stiffness can be intermittent, as can symptoms of radiculopathy. Radiculopathy refers to compression on the base, or root, of nerves that lead away from the spinal cord. Normally, these nerves fit comfortably through spaces between the vertebrae. These spaces are called intervertebral foramina. As the osteophytes form, they can impinge on this area and gradually make the fit between the vertebrae too snug.
The poor fit increases the chances that a minor incident, such as overdoing normal activities, may place excess pressure on the nerve root, sometimes referred to as a pinched nerve. Pressure may also accumulate as a direct consequence of osteophyte formation. The pressure on the nerve root causes severe shooting pain in the neck, arms, shoulder, and/or upper back, depending on which nerve roots of the cervical spine are affected. The pain is often aggravated by movement, but in most cases, symptoms resolve within four to six weeks.
Cervical spondylosis can cause cervical spondylitic myelopathy through stenosis- or osteophyte-related pressure on the spinal cord. Spinal stenosis is a narrowing of the spinal canal—the area through the center of the vertebral column occupied by the spinal cord. Stenosis occurs because of misaligned vertebrae and out-of-place or degenerating disks. The problems created by spondylosis can be exacerbated if a person has a naturally narrow spinal canal. Pressure against the spinal cord can also be created by osteophytes forming on the inner surface of vertebrae and pushing against the spinal cord. Stenosis or osteophytes can compress the spinal cord and its blood vessels, impeding or choking off needed nutrients to the spinal cord cells; in effect, the cells starve to death.
With the death of these cells, the functions that they once performed are impaired. These functions may include conveying sensory information to the brain or transmitting the brain's commands to voluntary muscles. Pain is usually absent, but a person may experience leg numbness and an inability to make the legs move properly. Other symptoms can include clumsiness and weakness in the hands, stiffness and weakness in the legs, and spontaneous twitches in the legs. A person's ability to walk is affected, and a wide-legged, shuffling gait is sometimes adopted to compensate for the lack of sensation in the legs and the accompanying, realistic fear of falling. In very few cases, bladder control becomes a problem.

Diagnosis

Cervical spondylosis is often suspected based on the symptoms and their history. Careful neurological examination can help determine which nerve roots are involved, based on the location of the pain and numbness, and the pattern of weakness and changes in reflex responses. To confirm the suspected diagnosis, and to rule out other possibilities, imaging tests are ordered. The first test is an x ray. X rays reveal the presence of osteophytes, stenosis, constricted space between the vertebrae, and misalignment in the cervical spine—in short, an x ray confirms that a person has cervical spondylosis. To demonstrate that the condition is causing the symptoms, more details are needed. Other imaging tests, such as magnetic resonance imaging (MRI) and computed tomography myelography, help assess effects of cervical spondylosis on associated nerve tissue and blood vessels.
An MRI may be preferred, because it is a noninvasive procedure and does not require injecting a contrast medium as does computed tomography myelography. MRIs also have greater sensitivity for detecting disk problems and spinal cord involvement, and the test allows the physician to create images of a larger area from various angles. However, these images may not show enough detail about the vertebrae themselves. Computed tomography myelography yields a superior image of the bones involved in cervical spondylosis. Added benefits include that it takes less time to perform and tends to be less expensive than an MRI. A good diagnosis may be reached with either a computed tomography myelography or an MRI, but sometimes complementary information from both tests is necessary. Nerve conduction velocity, electromyogram (EMG), and/or somatosensory evoked potential testing may help to confirm which nerve roots are involved.

Treatment

When possible, conservative treatment of symptoms is preferred. Conservative treatment begins with rest-either restricting normal activities to a less strenuous level or bed rest for three to five days. If rest is not adequate to relieve symptoms, a cervical orthosis may be prescribed, such as a soft cervical collar or stiffer neck brace to restrict neck movement and shift some of the head's weight from the neck to the shoulders. Cervical traction may also be suggested, either at home with the advice of a physical therapist or in a health-care setting.
Pain is treated with nonsteroidal anti-inflammatory drugs, such as aspirin or ibuprofen. If these drugs are ineffective, a short-term prescription for corticosteroids or muscle relaxants may be given. For chronic pain, tricyclic antidepressants can be prescribed. Although these drugs were developed to treat depression, they are also effective in treating pain. Once any pain is resolved, exercises to strengthen neck muscle and preserve flexibility are prescribed.
If the pain is severe, a short treatment of epidural corticosteroids may be prescribed with discretion. A corticosteroid such as prednisone can be combined with an anaesthetic and injected with a long needle into the space between the damaged disk and the covering of the nerve and spinal cord. Injection into the cervical epidural space relieves severe pain that is not managed with conventional treatment. Frequent use of this treatment is not medically recommended and is used only if the more conservative therapy is not effective.
If pain is continuous and does not respond to conservative treatment, surgery may be suggested. Surgery is usually not recommended for neck pain, but it may be necessary to address radiculopathy and myelopathy. Surgery is particularly recommended for people who have already developed moderate to severe symptoms of myelopathy, although age or poor health may prohibit that recommendation. The specific details of the surgery depend on the structures involved, but the overall goal is to relieve pressure on the nerve root, spinal cord, or blood vessels and to stabilize the spine.

Alternative treatment

Alternative therapy is not meant to replace conventional medical treatment, but it can be a useful adjunct. Its main roles are to relieve tension, manage pain, and strengthen neck and back muscles. Massage is one way to relieve tension, and yoga provides the additional benefit of strengthening muscles. Chiropractic and acupuncture have been reported to relieve the pain associated with disk problems, although great care needs to be taken to avoid exacerbating them. Practitioners of the Alexander technique or the Feldenkrais method can provide instruction on correct posture and exercise that may help prevent further symptoms. Vitamin and mineral supplementation along with herbal therapies and homeopathy can help build and rebalance the weakened structure.

Prognosis

The gradual progression of cervical spondylosis cannot be stopped; however, it doesn't always cause symptoms. For the individuals who do experience problems, conservative treatment is very effective in managing the symptoms. Nearly all people with neck pain, approximately 75% of persons with radiculopathy, and up to 50% of people with myelopathy find relief through therapy alone. For the remaining people with radiculopathy or myelopathy, surgery may be recommended. Surgery is deemed successful in 70-80% of cases.

Prevention

Since cervical spondylosis is part of the normal aging process, not much can be done to prevent it. It may be possible to ward off some or all of the symptoms by engaging in regular physical exercise and limiting occupational or recreational activities that place pressure on the head, neck, and shoulders. The best exercises for the health of the cervical spine are non-contact activities, such as swimming, walking, or yoga. Once symptoms have already developed, the emphasis is on symptom management rather than prevention.

Resources

Periodicals

McCormack, Bruce M., and Phillip R. Weinstein. "Cervical Spondylosis: An Update." Western Journal of Medicine 165 (July-August 1996): 43.

Key terms

Alexander technique — A technique developed by Frederick Alexander that focuses on the variations in body posture, muscles, and breathing. Defects in these functions can lead to stress, nervous tension or possible loss of function.
Bone spur — Also called an osteophyte, it is an outgrowth or ridge that forms on a bone.
Cervical — Referring to structures within the neck.
Computed tomography myelography — This medical procedure combines aspects of computed tomography scanning and plain-film myelography. A CT scan is an imaging technique in which cross-sectional x rays of the body are compiled to create a three-dimensional image of the body's internal structures. Myelography involves injecting a water-soluble substance into the area around the spine to make it visible on x rays. In computed tomography myelography or CT myelography, the water-soluble substance is injected, but the imaging is done with a CT scan.
Disk — A ringlike structure that fits between the vertebrae in the spine to protect the bones, nerves, and blood vessels. The outer layer is a tough, fibrous tissue, and the inner core is composed of more elastic tissue.
Feldenkrais method — A therapy based on creating a good self image by correction and improvements of body movements.
Magnetic resonance imaging (MRI) — An imaging technique that uses a large circular magnet and radio waves to generate signals from atoms in the body. These signals are used to construct images of internal structures.
Myelopathy — A disorder in which the tissue of the spinal cord is diseased or damaged.
Orthosis — An external device, such as a splint or a brace, that prevents or assists movement.
Osteophyte — Also referred to as bone spur, it is an outgrowth or ridge that forms on a bone.
Radiculopathy — Sometimes referred to as a pinched nerve, it refers to compression of the nerve root-the part of a nerve between vertebrae. This compression causes pain to be perceived in areas to which the nerve leads.
Spine — A term for the backbone that includes the vertebrae, disks, and spinal cord as a whole.
Stenosis — A condition in which a canal or other passageway in the body is constricted.
Traction — A medical treatment that exerts a pulling or extending force. Used for cervical problems, it relieves pressure on structures between the vertebrae and muscular tension.
Vertebrae — The ringlike component bones of the spine.

cer·vi·cal spon·dy·lo·sis

[MIM*184300]
spondylosis affecting the cervical vertebrae, intervertebral discs, and surrounding soft tissue.

cervical spondylosis

Etymology: L, cervix + Gk, spondylos, vertebra, osis, condition
a form of degenerative joint and disk disease affecting the cervical vertebrae and resulting in compression of the associated nerve roots. Symptoms include pain or loss of feeling in the affected arm and shoulder and stiffness of the cervical spine.

cervical spondylosis

A degenerative condition of the bones of the neck, with backward outgrowth of bone causing narrowing of the spinal canal or of the foramina for the spinal nerves, and possible compression of the spinal cord. This may lead to muscle weakness and walking disorders.

cervical

pertaining to the neck or to the cervix.

cervical ankylosis
ankylosis of the intervertebral joints. See also hypervitaminosis A.
cervical aplasia
segmental aplasia of the genital tract may be manifested by the absence or deformity of the cervix. Infertility is absolute. Diagnosis in large animals can be performed by rectal palpation; small animals may require surgical exploration.
cervical cirrhosis
caused by severe laceration at parturition; a rare cause of dystocia.
cervical curve
one of the vertebral curves of the body.
cervical dislocation
satisfactory method of euthanasia for laboratory mice, immature rats and poultry. Must be performed by an experienced person in order to achieve rapid and humane death.
cervical fixation
suturing of the cervix through the vaginal floor to the prepubic tendon. Used in the treatment of vaginal prolapse in cows.
cervical incompetence
damage to the cervix during parturition in the mare may cause its deformity and render it incapable of effectively closing off the uterus from the vagina. Infection of the uterus and infertility result.
incomplete cervical dilation
incomplete dilation of the cervix during parturition in adult cows, less commonly in heifers, may necessitate obstetrical, even cesarean, assistance; thought to be hormonal. See also ringwomb in ewes.
cervical inflammation
cervical instability, cervical malformation, cervical malarticulation
see canine wobbler syndrome.
cervical line lesions
of the tooth neck characterized by progressive, subgingival, osteoclastic resorption. These occur commonly in cats. See odontoclastic resorption.
cervical lymphadenitis
infection with abscessation of cervical lymph nodes in guinea pigs; usually caused by Streptococcus zooepidemicus.
cervical massage
suitable for use only in cows. The fetus is pulled up into the cervix and light traction maintained while a well-lubricated hand is pushed gently between the cervix and the fetus. This is done repeatedly and continued if there is no evidence of trauma. The cervix may dilate sufficiently to allow normal delivery of the calf.
cervical mucus
from the cervix. Its presence in liberal amounts is used as an indication of estrus.
cervical paralysis
inability to lift the head, usually accompanied by paralysis of all four limbs.
cervical plexus
see cervical plexus.
cervical rib
a supernumerary rib arising from a cervical vertebra.
cervical spinal cord lesion
includes fracture-dislocation, cervical vertebral abscess, compression due to exostosis, spinal myelitis and myelacia, congenital lesions including spinal canal stenosis.
cervical spine
cervical vertebrae.
cervical spondylolisthesis, spondylopathy
see canine wobbler syndrome.
cervical spondylosis
see cervical ankylosis (above).
cervical static stenosis
one of the two syndromes listed under cervical vertebral stenotic myelopathy; characterized by compression of the cord at C5 to C7 in large male horses 1-4 years of age; the position of the neck is immaterial; the resulting syndrome is characterized by an insidious onset of ataxia. See also enzootic equine incoordination.
cervical stenotic myelopathy
focal myelopathy caused by compression of the spinal cord by excessive flexion of the neck in patients, especially dogs, in which there is a pre-existing narrowing of one of the two vertebral foramina in one or more vertebrae, especially cervical vertebrae. See also degenerative myeloencephalopathy.
cervical swab
swab of the os cervix for bacterial and virological examination for pathogens likely to affect fertility adversely. Used in fertility examination of cases of prolonged infertility in ruminants. See also uterine swab.
cervical syndrome
clinical signs caused by a lesion of the spinal cord between C1 and C5. They include tetraparesis to tetraplegia or hemiparesis to hemiplegia, hyperreflexia, hypertonia, depressed postural responses and sometimes cervical pain.
cervical trauma
most common are lacerations during parturition; resulting adhesions and fibrosis may cause subsequent dystocia.
cervical vertebrae
the skeleton of the neck, in most mammals comprising seven vertebrae, in birds up to 25.
cervical vertebra fracture
in horses occurs as a result of head-on collisions at speed; causes recumbency and inability to move limbs voluntarily, but there is full consciousness and patient can eat and drink if assisted.
cervical vertebral malformation malarticulation syndrome
cervical vertebral stenotic myelopathy
one of the causes of incoordination in young horses. See also enzootic equine incoordination.
References in periodicals archive ?
As your symptoms have been present for some time it does not sound like an injury but more likely to be due to cervical spondylosis.
Fusion rates in multilevel cervical spondylosis comparing allograft fibula with autograft fibula in 126 patients.
The patient has cervical spondylosis, nerve root type," Qu said.
Q I AM 75 years of age and for 13 years have suffered with cervical spondylosis.
Mike Reed, defending, told the court: "Mr Stephens suffers from cervical spondylosis - a degenerative bone disease of the upper spine and neck.
Defence lawyer Mike Reed said Stephens used the drug to combat the pain of cervical spondylosis, instead of relying on morphine.
She wanted to be with her family because she is very sick with cervical spondylosis and lumbar spine stenosis (or weakened vertebrae).
6 Osteoarthritis of the vertebrae in your neck, which is called cervical spondylosis, where new bone is pressing on a spinal nerve.
But she was awarded pounds 39,200 for being forced to retire early because of a previous medical condition, cervical spondylosis.