Cervical Spondylosis

Cervical Spondylosis refers to common agerelated changes in the area of the spine at the back of the neck. With age, the vertebrae (thecomponent bones of the spine) gradually form bone spurs, and their shockabsorbing disks slowly shrink. These changes can alter thealignment and stability of the spine. They may go unnoticed, or they may produce problems related to pressure on the spine andassociated nerves and blood vessels. This pressure can cause weakness, numbness, and pain in various areas of the body. In severecases, walking and other activities may be compromised.

Causes and symptoms: As people age, shrinkage of the vertebral disks prompts the vertebrae to form osteophytes to stabilize the back bone. However, theposition and alignment of the disks and vertebrae may shift despite the osteophytes. Symptoms may arise from problems with one ormore disks or vertebrae. Osteophyte formation and other changes do not necessarily lead to symptoms, but after age 50, half of the population experiencesoccasional neck pain and stiffness. As disks degenerate, the cervical spine becomes less stable, and the neck is more vulnerable toinjuries, including muscle and ligament strains. Contact between the edges of the vertebrae can also cause pain. In some people, thispain may be referred—that is, perceived as occurring in the head, shoulders, or chest, rather than the neck. Other symptoms may includevertigo (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, orroot, of nerves that lead away from the spinal cord. Normally, these nerves fit comfortably through spaces between the vertebrae. Thesespaces are called intervertebral foramina. As the osteophytes form, they can impinge on this area and gradually make the fit between thevertebrae too snug. The poor fit increases the chances that a minor incident, such as overdoing normal activities, may place excess pressure on the nerveroot, sometimes referred to as a pinched nerve. Pressure may also accumulate as a direct consequence of osteophyte formation. Thepressure on the nerve root causes severe shooting pain in the neck, arms, shoulder, and/or upper back, depending on which nerve rootsof the cervical spine are affected. The pain is often aggravated by movement, but in most cases, symptoms resolve within four to sixweeks. 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 beexacerbated if a person has a naturally narrow spinal canal. Pressure against the spinal cord can also be created by osteophytes formingon the inner surface of vertebrae and pushing against the spinal cord. Stenosis or osteophytes can compress the spinal cord and its bloodvessels, 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 sensoryinformation to the brain or transmitting the brain's commands to voluntary muscles. Pain is usually absent, but a person may experienceleg 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. Invery few cases, bladder control becomes a problem.

Treatment: When possible, conservative treatment of symptoms is preferred. Conservative treatment begins with rest-either restricting normalactivities to a less strenuous level or bed rest for three to five days. If rest is not adequate to relieve symptoms, a cervical orthosis maybe prescribed, such as a soft cervical collar or stiffer neck brace to restrict neck movement and shift some of the head's weight from theneck to the shoulders. Cervical traction may also be suggested, either at home with the advice of a physical therapist or in a health-caresetting. Pain is treated with nonsteroidal anti-inflammatory drugs, such as aspirin or ibuprofen. If these drugs are ineffective, a short-termprescription 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 tostrengthen 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 prednisonecan be combined with an anaesthetic and injected with a long needle into the space between the damaged disk and the covering of thenerve 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 forneck pain, but it may be necessary to address radiculopathy and myelopathy. Surgery is particularly recommended for people who havealready developed moderate to severe symptoms of myelopathy, although age or poor health may prohibit that recommendation. Thespecific 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.

STATISTICS: Patients with cervical spondylosis or thoracolumbar spinal deformity had significantly higher rates of the other spinal diagnosis. This correlation was increased with increased severity of disease. Patients with both diagnoses were significantly more likely to have received a spine fusion. Further research is warranted to establish the cause of this correlation.