Cervical spondylosis is a condition which is characterised by wear and tear of spinal discs and joints in the neck region with increasing age. This condition is also known as cervical arthritis or arthritis of the neck. Cervical spondylosis is a common condition affecting more than 85% of people above the age of 60. The cervical spine is comprised of seven small vertebrae, which begin at the bottom of the skull to form the neck.
Causes and risk factors of Cervical Spondylosis
The following are some of the causes and risk factors of cervical spondylosis.
Loss of fluid: Age-related changes lead to loss of water content in the spinal discs. This results in shrinkage of discs, reduced disc space and increased bony contact, causing pain.
Bone overgrowth: The spine naturally generates additional bone growth in order to support the vertebrae when discs are degenerated. These bone overgrowths are known as bone spurs.
Disc herniation: As age progresses, it results in cracks or tears in the spinal disc area leading to leakage of contents outside the disc, compressing the adjacent nerves and tissues.
Stiffness of ligaments: The ligaments of the spine which connect the vertebrae together become stiff with age, leading to restricted neck movement and flexibility.
The risk factors associated with cervical spondylosis include:
- Age
- History of neck injuries
- Additional strain on the neck due to occupational activities
- Repetitive neck movements for prolonged durations
- Incorrect sitting/standing postures affecting the neck position
- Obesity
- Genetics
Signs and symptoms of Cervical Spondylosis
Majority of people may not present with any symptoms, although some typical symptoms include:
- Pain and stiffness in the neck
- Increased pain with movement of the neck
- Headache
- Weakness of muscles
- Tingling and numbness in the arms and shoulders
- Dizziness
- Muscle spasms
- Clicking sound while moving the neck
Diagnosis of Cervical Spondylosis
Cervical spondylosis is diagnosed by knowing medical history, physical examination and diagnostic imaging scans.
Physical examination: Physical examination involves evaluation of strength in the arms, hands and legs, flexibility of the neck, reflexes, pain trigger points and balance while walking.
Diagnostic scans: X-rays are used to identify bone spurs, alignment of vertebrae and disc height. A CT scan gives a more detailed view of bony structures than X-rays. MRI scans allow for detailed visualization of nerves, muscles and other soft tissues of the spinal cord.
Treatment of Cervical Spondylosis
Treatment of cervical spondylosis involves conservative management with physical exercises and pain relief medications and surgical interventions for people who fail to respond to non-surgical methods.
Conservative management
Physical exercises: Physical therapy includes strengthening exercises for muscles of the neck and the upper back region. It is carried out for a course of about four to six weeks.
Medications: Pain relief medications such as non-steroid anti-inflammatory drugs (NSAIDs), muscle relaxants, anti-depressants, and oral steroids are given.
Medical equipment: Use of cervical collars and cervical pillows during night time can help in maintaining the neck posture and provides symptomatic relief from pain and spasms.
Other conservative methods include heat therapy, cold therapy, massages, cervical traction and epidural injections.
Surgical management
Surgical management of cervical spondylosis depends upon the associated clinical syndrome, medical history, causative factors and the location of damage. It involves two approaches: Anterior and posterior.
The surgeries that are performed from the front region of the neck are called anterior approaches. They include:
- Anterior cervical discectomy and fusion: Removal of the damaged disc between the vertebrae followed by placement of bone graft for strength and stabilization.
- Anterior cervical corpectomy: Removal of damaged vertebrae, bone spurs and disc spaces followed by fusion.
The surgeries performed from the back region of the neck are called posterior approaches. They include:
- Cervical laminectomy: Removal of bony region (lamina) surrounding the spinal canal to relieve compression in the neck region.
- Cervical laminoplasty: Reshaping of the bone to increase spinal canal space and relieve compression.
