What Is Cervical Spondylosis?
Cervical spondylosis is also called cervical osteoarthritis. It is a condition involving changes to the bones, discs, and joints of the neck. These changes are caused by the normal wear-and-tear of aging. With age, the discs of the cervical spine gradually break down, lose fluid, and become stiffer. Cervical spondylosis usually occurs in middle-aged and elderly people.
As a result of the degeneration of discs and other cartilage, spurs or abnormal growths called osteophytes may form on the bones in the neck. These abnormal growths can cause narrowing of the interior of the spinal column or in the openings where spinal nerves exit, a related condition called cervical spinal stenosis.
Cervical spondylosis most often causes neck pain and stiffness. Although cervical spondylosis is rarely progressive, corrective surgery can be helpful in severe cases.
What Are the Risk Factors for Cervical Spondylosis?
Aging is the major factor for developing cervical osteoarthritis (cervical spondylosis). In most people older than age 50, the discs between the vertebrae become less spongy and provide less of a cushion. Bones and ligaments get thicker, encroaching on the space of the spinal canal.
Another factor might be a previous injury to the neck. People in certain occupations or who perform specific activities -- such as gymnasts or other athletes -- may put more stress on their necks.
Poor posture might also play a role in the development of spinal changes that result in cervical spondylosis.
What Are the Symptoms of Cervical Spondylosis?
The symptoms of cervical spondylosis include:
- Neck stiffness and pain
- Headache that may originate in the neck
- Pain in the shoulder or arms
- Inability to fully turn the head or bend the neck, sometimes interfering with driving
- Grinding noise or sensation when the neck is turned
Less common, or "atypical," symptoms include vertigo, headache, palpitation, nausea, discomfort in your abdomen or GI system, tinnitus, blurred vision, and memory problems (hypomnesia). Some studies also show that chronic neck pain from causes such as spondylosis have been linked to higher blood pressure.
Symptoms of cervical spondylosis tend to improve with rest. Symptoms are most severe in the morning and again at the end of the day.
If cervical spondylosis results in pressure on the spinal cord (cervical stenosis), it can put pressure on the spinal cord, a condition called cervical myelopathy. Symptoms of cervical spondylosis with myelopathy include:
- Tingling, numbness, and/or weakness in the arms, hands, legs, or feet
- Lack of coordination and difficulty walking
- Abnormal reflexes
- Muscle spasms
- Loss of control over bladder and bowel (incontinence)
Another possible complication of cervical spondylosis is cervical radiculopathy, when bone spurs press on nerves as they exit the bones of the spinal column. Pain shooting down into one or both arms is the most common symptom.
How Is Cervical Spondylosis Diagnosed?
The doctor will generally begin by asking you about symptoms and taking a medical history. This will be followed by a physical exam of the body, with a focus on the neck, back, and shoulders. The doctor is also likely to test reflexes and the strength of hands and arms, check for loss of sensation, and watch you walk.
Other tests that might be done include imaging exams such as X-rays, computed tomography (CT), and magnetic resonance imaging (MRI). MRI scans use large magnets, radio waves, and a computer to produce the best images of the body. You might also be referred to a neurologist.
What Are the Treatments for Cervical Spondylosis?
In most cases, cervical spondylosis treatments are conservative. They include:
- Use of nonsteroidal anti-inflammatory drugs (NSAIDs) or other non-narcotic products to relieve pain from inflammation
- Chiropractic manipulation that can help to control episodes of more severe pain
- Wearing a cervical collar to limit movement and provide support
- Other forms of physical therapy, including the application of heat and cold therapy, traction, or exercise
- Injecting drugs (corticosteroids and a local anesthetic) into the joints of the spine or the area surrounding the spine, known as epidural steroid injection or cervical facet joint injection
When Is Surgery Needed for Cervical Spondylosis?
Cervical spondylosis tends to be a chronic (long-term) condition. But in most cases, it is not progressive. Surgery is required only in rare cases. The goal of surgery is to remove the source of pressure on the spinal cord and nerves. The surgery may also include adding stabilization in the form of implants or through fusion of the vertebrae. But surgery is considered only when there is a severe loss of function. For instance, it might be considered if you had a progressive loss of feeling and function in your arms, legs, feet, or fingers. Any type of spinal cord compression could result in permanent functional disability.
The surgeon can approach the cervical spine from the front (anterior) or the back (posterior). Approaching from the front might be used to remove the discs and spurs that are causing pressure. The disc may be replaced with an implant. A more extensive surgery calls for the removal of both discs and parts of the vertebra. These parts are replaced with a bone graft or implant.
Approaching from the back would be used to perform either a laminectomy or a laminoplasty. In a laminectomy, the rear parts of the vertebrae in the neck -- the lamina and spinous processes -- are removed. In a laminoplasty, the vertebra is left in place, but is cut free along one side. Both procedures relieve pressure on the spinal cord or nerves.
As with any surgery, there is risk of infection or complications with anesthesia. Surgery is usually followed by a rehabilitation program.