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Cervical spondylosis is a condition in which there is deterioration of the vertebrae, discs, and ligaments in the neck or cervical spine.
It is also known as arthritis of the neck, cervical osteoarthritis, or degenerative osteoarthritis.
The condition usually appears in men and women older than 40 years, and it progresses with age.
Men usually develop it at an earlier age than women do. It can lead to bouts of stiffness and neck pain.
What happens in cervical spondylosis?
The cervical spine is the name given to the seven small vertebrae that form the neck. They start at the base of the skull.
Cervical spondylosis is a kind of arthritis.
In cervical spondylosis, the edges of the vertebrae often develop bone spurs called osteophytes. In time, the discs get thinner, and their function as a shock absorber is lost. This increases the risk of symptoms.
Swollen neck joints, called facet joints, can press or pinch nearby nerves roots or the spinal cord itself.
This can cause tingling or sensation of "pins and needles" in the extremities, and sometimes even pain in the limbs.
In some cases, there may be a loss of feeling and coordination. Some patients may find walking difficult.
It is normal for people to experience degenerative changes as they get older. The American Academy of Orthopaedic Surgeons (AAOS) estimates that nearly 50 percent of people start to have worn disks from when they reach middle-age.
Often, these do not cause symptoms, but some people experience pain. The AAOS add that over 65 percent of people over the age of 65 years live with cervical arthritis.
What are the symptoms of cervical spondylosis?
In most cases, patients just experience a pain in the neck and some stiffness, and they may have the occasional headache.
Neck pain may spread from the neck to reach the shoulders, arms and hands, and the base of the skull. The pain may be worse when the head is moved.
Neck stiffness is more common after a long period of inactivity, for example, after sleeping.
Headaches tend to start at the back of the head and then gradually move to the upper half of the front.
The brain can be affected if blood vessels are compressed, as this can affect the blood supply to the brain. This may result in dizziness, and even blackouts.
Other, less frequent, problems may include loss of bowel or bladder function and coordination difficulties. Arms and legs may become weak, and there may be lack of dexterity. Some people may have dysphagia, or difficulty swallowing, if the bones press against the esophagus.
What causes cervical spondylosis?
Cervical spondylosis happens because of long-term, or chronic, degeneration, or wear-and-tear of the cervical spine. A previous neck injury may also cause eventual cervical spondylosis.
Some long-term activities, such as carrying axial loads, practicing martial arts, or being a professional dancer or gymnast, may increase the risk of developing cervical spondylosis.
Some researchers say that a genetic cause is possible, because there have cases of the condition running in families.
Smoking may also increase the risk of developing cervical spondylosis.
How is cervical spondylosis diagnosed?
If a patient aged over 40 years seeks medical advice for pain or stiffness in the neck, a physician will normally suspect cervical spondylosis.
Diagnosis may involve an MRI.
A number of tests can help to diagnose the condition.
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, to bring the chin down to their shoulder blades.
Hand and feet reflexes will be tested. The patient may be asked to walk, to check for gait and posture.
Strength and sensation will be tested in both the upper extremities and lower extremities.
An x-ray can reveal any physical damage to the spine, and whether there are any lumps of extra bone, known as osteophytes.
If the patient has severe, radiating, arm pain that is not improving, an MRI test may be used to look at the nerve roots, because there could be a herniated disc.
An MRI scan can also help to decide whether surgery is indicated, and where the specific problem is located. It also is helpful in looking at the soft tissues.
A myelogram may be carried out. In this test, a colored dye is injected into the spine. This dye shows up in imaging scans, such as x-rays.
A CT scan can help to assess the bony structure of the cervical spine.
Electromyography (EMG) and nerve conduction studies (NCS) are often used to assess the specific muscles and nerves that may be involved.
What is the treatment for cervical spondylosis?
In most cases, cervical spondylosis is without symptoms. When symptoms do occur, they tend to resolve themselves over time, even without treatment.
However, some treatments are available that can help to reduce the symptoms.
To relieve the pain, most people can use over-the-counter (OTC) drugs that do not need a prescription. Nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen, can help.
Patients with asthma, liver disease, kidney disease, heart disease, hypertension, or a history of stomach problems should not take NSAIDs. For severe pain, the doctor may prescribe other pain relievers.
Muscle relaxants are useful if the patient has neck spasms, in which the neck muscles tighten suddenly. Cyclobenzaprine or a similar muscle relaxant may be prescribed.
Amitriptyline is a drug normally used for treating depression, but it is sometimes prescribed for relentless pain that has not responded to other treatments.
Gabapentin may be prescribed.
A steroid injection in the neck may help with very severe pain.
Examples of steroid injections include a trigger-point injection that can be done in a physician's office, a facet joint injection, or a cervical epidural steroid injection (ESI). An ESI must be done under fluoroscopy, with the help of an x-ray.
Physical therapy can help alleviate symptoms.
In some cases, the symptoms of pain and stiffness continue to get worse, and neurological loss occurs.
In some cases, surgery may be offered to treat radiating arm pain that persists or if there is a loss of sensation, muscle weakness occurs, or if there is a loss of bowel or bladder function.
If MRI results show that there is nerve root compression or pressure on the spinal cord, known as myelopathy, the patient may benefit from surgery.
The surgeon may remove some osteophytes, or protruding pieces of bone, and possibly also portions of a disc to take pressure off the spinal nerve root or spinal cord.
Another type of surgery is cervical fusion. This will reduce pressure on the root joints and the spinal cord.
Preventing cervical spondylosis
Cervical spondylosis cannot be prevented, but symptoms related to it can be controlled, for example, preventing repetitive stress on the neck.
For example, an ergonomic specialist may adjust a patient's work station to minimize repetitive stress on the neck.
Not smoking, exercising sensibly, and stretching are all ways to avoid symptoms.
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