Swollen neck joints can press or pinch nearby nerves roots or the spinal cord itself, resulting in pins and needles, and sometimes even pain in the limbs; in some cases there may be loss of feelings and coordination. Some patients may find walking difficult.
According to the National Health Service, most of us will have had some degree of cervical spondylosis symptoms by the time we reach 70 years of age.
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.
In most cases patients just experience a pain in the neck and a bit of stiffness, and perhaps the occasional headache.
- Neck pain - the pain may spread, reaching the shoulders and the base of the skull. Pain gets worse when the head is moved. The pain can reach the hand and arms. Frequency of pain depends on the number of flare ups. However, some patients have long-term (chronic) pain.
- Neck stiffness - this is more common after a long period of inactivity (e.g. sleep).
- Headaches - generally start at the back of the head and then gradually move to the upper half of the front.
- Other problems - these are more rare, but may include bladder function problems, coordination difficulties. Arms and legs may become weak, and there may be lack of dexterity.
- When the brain is affected - if blood vessels are pressed the blood supply to the brain may be affected slightly. This may result in dizziness, and even blackouts.
- Dysphagia - (rare) swallowing difficulties when the bones press against the esophagus.
What causes cervical spondylosis?Cervical spondylosis is caused by long term (chronic) degeneration (wear-and-tear) of the cervical spine. Previous neck injury may also cause eventual cervical spondylosis.
Some long-term activities, such as carrying axial loads, professional dancing and gymnastics may contribute to a higher risk of developing cervical spondylosis. Cervical spondylosis tends to be more common among people who practiced martial arts for many years.
Smoking may also increase the risk of developing cervical spondylosis.
How is cervical spondylosis diagnosed?If a patient comes to a GP (general practitioner, primary care physician, family doctor) with neck pain or stiffness and is over 40, cervical spondylosis will be suspected. The following diagnostic procedures and tests may be carried out:
- Physical examination: The doctor may ask the patient to move the head sideways to check the range of motion of the head - the patient may also be asked to move the head forward (bring your chin down to your shoulder blades). Hand and feet reflexes may also be tested. The patient may be asked to walk, in order to check for gait and posture.
- Myeologram: A colored dye is injected inside the spine. This dye shows up in imaging scans, such as x-rays.
- Other imaging scans - if the patients radiating arm pain is not getting better and remains severe the doctor may order an MRI test to look at the nerve roots and determine whether there is a herniated disc. An MRI scan may also be ordered when the doctor is considering whether surgical intervention is necessary.
- X-Ray: This may reveal any physical damage to the spine, and whether there are any lumps of extra bone (osteophytes).
What is the treatment for cervical spondylosis?Generally, cervical spondylosis will resolve itself over time, even without treatment. In some rare cases this does not happen and the pain and stiffness get worse.
Pain - OTC (over-the-counter, no prescription required) NSAIDs will help most people with pain. Patients with asthma, liver disease, heart disease, hypertension and a history of stomach problems should not take NSAIDs. For severe pain the doctor may prescribe codeine.
Muscle relaxants - if neck muscle abruptly tighten (spasms), diazepam or a similar muscle relaxant may be prescribed.
Amitriptyline - originally designed to treat depression, this medication is sometimes used for relentless pain that has not responded to other treatments.
Gabapentin - may be prescribed for pins and needles.
Very severe pain - a steroid medication may be injected into the neck.
Surgery - surgery is rare and only considered if the radiating arm pain does not respond to treatment and persists. The doctor will also look at MRI results and determine whether there is nerve root compression or pressure on the spinal cord. Patients with myelopathy may also benefit from surgery. According to the National Health Service, patients should not wear a neck brace for a long time, because it might actually worsen symptoms.
Today there are several different surgical approaches to cervical spondylosis. The spine can be approached form the front, side or rear. The surgeon will usually remove some osteophytes and possible portions of a disc - this will reduce pressure on root joints and the spinal cord. According to the National Health Service, patients should not wear a neck brace for a long time, because it might actually worsen symptoms.
Written by Christian Nordqvist