What Is Cervical Spondylosis? What Causes Cervical Spondylosis?

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Main Category: Bones / Orthopaedics
Also Included In: Arthritis / Rheumatology;  Pain / Anesthetics
Article Date: 24 Nov 2009 - 6:00 PST

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Cervical spondylosis is a general term for age-related wear and tear affecting the joints in the neck. It is also known as cervical osteoarthritis and degenerative osteoarthritis. This condition usually appears in men and women older than 40 and progresses with age. Men usually develop it at an earlier age than women do. It can lead to episodes of stiffness and neck pain.

With age, the bones and cartilage that make up the backbone and neck gradually deteriorate. Sometimes there is formation of irregular bony outgrowths called bone spurs. These changes are characteristic of cervical spondylosis. Even so, many people with signs of cervical spondylosis on X-rays manage to escape the associated symptoms, which include pain, stiffness and muscle spasms.

In more serious cases of cervical spondylosis, changes in the structure of bones or joints in the neck can cause nerves to get pinched or compressed. They may also cause them to press against nearby blood vessels. This can temporarily block the flow of blood and lead to more serious symptoms, such as lack of feeling in the hands and legs, a loss of co-ordination and, less commonly, loss of bladder control.

Cervical spondylosis is primarily an age-related condition. In most cases the symptoms can be controlled using a combination of over-the-counter (OTC) medication, such as ibuprofen, and exercise. In more serious cases where there is evidence of damage to the nerves, surgery may be required.

According to Medilexicon's medical dictionary, Cervical spondylosis is "spondylosis affecting the cervical vertebrae, intervertebral discs, and surrounding soft tissue."

What are the signs and symptoms of cervical spondylosis?

A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.

The majority of people with cervical spondylosis will only experience episodes of stiffness and neck pain.

Other symptoms can occur:

• If there is a slipped disc or changes in bone structure, it pinches or irritates a nearby nerve (cervical radiculopathy).


• if the bones in the neck begin to press against blood vessels.


• if the spinal column becomes narrower, compressing the nerves inside (cervical myelopathy).

Symptoms of cervical radiculopathy: If a nerve becomes pinched or irritated, the whole length of the nerve can be affected. Depending on the affected nerve, there can be pain radiating from the neck into the arm, shoulder, head or chest. Also, there may be some numbness in the part of the body that the nerve travels to.

Symptoms of compressed blood vessels: If the bones in the neck begin to press against the blood vessels, it can reduce the flow of blood to the brain. The reduction of blood is too small to cause any serious problems. However, it can cause brief blackouts and episodes of dizziness, especially when looking in an upward direction. In some cases, the bones can also press against the esophagus. This can lead to difficulties in swallowing (dysphagia).

Symptoms of cervical myelopathy: Cervical myelopathy can cause broader and more serious symptoms. The compression of the nerves inside the spinal column can interfere with the signals that travel between the brain and the rest of the body. Symptoms include:

• a lack of coordination
• muscle weakness in the arms or legs
• difficulty walking
• urinal incontinence - loss of bladder control
• fecal incontinence - loss of bowel control
• abnormal reflexes

What causes cervical spondylosis?

Age-related wear and tear is probably the basic cause of cervical spondylosis. Specific changes occurring with age include:

• Drying and loss of elasticity in the spinal and cervical disks.
• Bulging and sometimes herniation of disks. As a result, disk material protrudes from between two vertebrae.
• Stiffening of the ligaments connecting neck bones and muscles.

The structure of the spine

The spine is made up of vertebrae, discs, and nerves. Vertebrae are sections of bone that make up the structure of the spine, and protect the nerves. The vertebrae are supported and cushioned by discs of cartilage. Cartilage is a type of tissue that is tough and flexible. With age the cartilage inside the disks becomes harder and more brittle. As a result, they provide less support to the vertebrae resting on the disk. This causes the spine to become less stable.

The body will compensate for this by producing small lumps of extra bone to better support the neck and stiffen the spine. These lumps of extra bone are known as bone spurs or osteophytes which often cause more problems. They can cause the spine to become too rigid leading to the symptoms of stiffness and neck pain. In addition, the changes in bone structure can compress nearby nerves and blood vessels and cause symptoms of more widespread pain.

Herniated disc

A herniated or 'slipped' disk can also lead to neck pain in cases of cervical spondylosis. As the disc of cartilage becomes harder and more brittle, repeated strain on the neck can cause the disc to split, or rupture. If there is a rupture, some of the soft core of tissue inside the disc can press against a nerve leading to pain.

Cervical myelopathy

In the most serious cases of cervical spondylosis, the changes in bone structure will cause the spinal column to contract (spinal stenosis). The spinal column contains a thick bundle of nerves that run from the brain to the rest of the body. If the spinal column contracts too far, these nerves can be damaged, and this will lead to a disruption of the signals sent from the brain to the rest of the body. This can lead to symptoms of numbness, loss of coordination, lack of bladder and bowel control and muscle weakness.

Left untreated, some cases of cervical myelopathy can lead to permanent nerve damage, resulting in disability.

How is cervical spondylosis diagnosed?

Cervical spondylosis can usually be recognized by the symptoms. In addition, history along with an examination may suggest cervical spondylosis. However, to rule out other possibilities and confirm the diagnosis, various tests can be carried out:

• Physical examination: It is necessary to evaluate the range of motion in the neck (by tilting head toward each of the shoulders and rotating the neck from side to side).


• Neurological exam: To find out if there is pressure on the spinal nerves or spinal cord. Testing of the reflexes in the hands and feet and checking there is full sensation in all the limbs. Problems with the reflexes or a lack of sensation could indicate the presence of nerve damage.


• X-Ray: To identify whether there is any damage to the structure of the spine and to detect the presence of osteophytes.


• Computer topography (CT) and MRI Scans: A computer topography (CT) and MRI scans are usually only used if there is the possibility of nerve damage. CT scans produce a three-dimensional image that is much more detailed than an X-ray; the bones involved can be seen more clearly. An MRI scan, can also detect any damage or problems with the nerves.


• Myeologram: A colored dye is injected inside the spine in order to make the spinal column more visible during an X-ray or CT scan.

What are the risk factors for developing cervical spondylosis?

A risk factor is something which raises the likelihood of developing a disease or condition. For example, obesity increases the risk of developing diabetes type 2; therefore, obesity is a risk factor for diabetes.

Aging and wear and tear on the spine are the major risk factors for cervical spondylosis. Some individuals may be more likely to develop cervical spondylosis if they have had a neck injury.

Seek health professional advice if:

• neck pain does not respond to over-the-counter pain medications
• pain worsens
• numbness in the arms or legs develops

What is the treatment for cervical spondylosis?

The signs and symptoms of cervical spondylosis may decrease or stabilize without treatment, 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:

• 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.


• Taking nonsteroidal anti-inflammatory drugs (NSAID) such as ibuprofen (Advil, Motrin, others) for pain relief. NSAIDs may not be suitable in people with asthma, high blood pressure, liver disease, heart disease or a history of stomach and digestive disorders. If pain is more severe, the mild opiate painkiller codeine may be prescribed and can be taken in combination with NSAIDs.


• Wearing a neck brace (cervical collar) during the day to help limit neck motion and reduce nerve irritation.

Treatment of more serious cases:

• Hospitalization with bed rest and traction on the neck. During 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. It is injected between the vertebrae. The injection combines corticosteroid medication with local anesthetic to reduce pain and inflammation.

Surgery

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

• Frontal approach (anterior). The surgeon makes an incision in the front of the neck and moves aside the windpipe and esophagus to expose the cervical spine. The herniated disk or bone spurs can be removed, depending on the underlying problem. With disk removal, the surgeon will fill the gap with a graft of bone or other implant.


• Back approach (posterior). The surgeon may opt to remove or rearrange bone from the back of the neck. The operation, called a laminectomy, removes the back part of the bone over the spinal canal through an incision in the back of the neck.


• Fusion surgery. Fusion surgery is used to treat vertebrae that have slipped out of position. The surgeon uses metal rods to fuse the vertebrae back into place.

Risks of surgery

There are several risks of these procedures, they 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 be successful in eliminating all the problems associated with the condition.

Amitriptyline

If pain persists for more than a month, and has not responded to other painkillers, a medicine called amitriptyline might be prescribed. This medicine was originally designed to treat depression, but it was found also useful in treating pain. The side effects when taking amitriptyline include:

• blurred vision
• constipation
• difficulty urinating
• drowsiness
• dry mouth

Amitriptyline should not be taken by people with a history of heart disease.

Gabapentin

If the pain does not respond to amitriptyline an alternative medicine called gabapentin can be used. This medicine that was originally designed to prevent seizures in people with epilepsy but, like amitriptyline, it has also been found to be useful for treating nerve pain. Possible side-effects of gabapentin include:

• dizziness
• drowsiness
• loss of coordination
• tiredness

Gabapentin therapy should not be stopped abruptly as there can be withdrawal symptoms. These could include:

• anxiety
• insomnia
• nausea
• pain
• sweating

To prevent withdrawal symptoms, the dose should be reduced gradually over the course of a week.

Muscle relaxants

In the case of an episode of acute severe pain, a short course of diazepam may be prescribed. Diazepam is largely used as a sedative or tranquillizer, but it can also be used to relax muscles.

Diazepam can cause sleepiness; as a result driving should be strictly avoided. Avoid excessive drinking because diazepam will also make the effects of alcohol worse. Diazepam has the potential to be habit-forming and therefore is not usually prescribed for more than a seven day course of the medication.

Exercise and lifestyle changes

• A referral to a physiotherapist in order to learn some exercise techniques that will strengthen the neck muscles and reduce strain on the spine.


• Low-impact aerobic exercises such as swimming or walking may be beneficial.


• The use of a firm pillow at night is preferred to two soft pillows, as this will reduce the strain on the neck.


• The long-term use of a neck brace or collar is not recommended as it can make the symptoms worse. Unless there are special instructions, the brace should not be worn for more than a week.


• Alternative therapies such as osteopathic manipulative medicine, massage, trigger-point therapy, chiropractic and acupuncture may be utilized to control pain.

What are the complications of cervical spondylosis?

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

How is cervical spondylosis prevented?

Cervical spondylosis is part of the ageing process and cannot be prevented but the risks can be reduced 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 avoid holding the head in the same position for long periods.


• Practicing good posture, with the neck aligned over your shoulders (while standing, sitting, working at the computer, driving and sleeping to help to prevent damage to the spine).


• Protecting the neck from injury by using a seat belt when in a car.


• The best exercises for the health of the cervical spine are low-impact activities, such as swimming, walking, or yoga.


• Lowering the risk of neck injury by using the correct equipment and techniques when playing sports, may reduce the risk of developing cervical spondylosis.

If you experience mild neck pain or stiffness:

• Regularly walk or engage in low-impact aerobic activity
• Take a long, hot shower every day
• Take over-the-counter pain relievers
• Wear a cervical collar (available in a drugstore) during the day

Written by Stephanie Brunner (B.A.)
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today