Cervical Spondylosis is a degenerative condition of the cervical spine found almost universally in persons over 50 years of age.
It occurs early in persons pursuing ‘white collar jobs’ or those susceptible to neck strain because of keeping the neck constantly in one position while reading, writing etc.
Pathology of Cervical Spondylosis
The pathology begins in the intervertebral discs. Degeneration of disc results in reduction of disc space and peripheral osteophyte formation.
The posterior intervertebral joints get secondarily involved and generate pain in the neck.
The osteophytes impinging on the nerve roots give rise to radicular pain in the upper limb. Exceptionally, the osteophytes may press on the spinal cord, giving rise to signs of cord compression.
Cervical spondylosis occurs most commonly in the lowest three cervical intervertebral joints (the commonest is at C₁-C₂).
Symptoms of cervical Spondylosis
Complaints are often vague. Following are the common presentations:
• Pain and stiffness: This is the commonest presenting symptom, initially intermittent but later persistent.
Occipital headache may occur if the upper-half of the cervical spine is affected.
• Radiating pain: Patient may present with pain radiating to the shoulder or downwards on the outer aspect of the forearm and hand.
There may be paraesthesia in the region of a nerve root, commonly over the base of the thumb (along the C6, nerve root). Muscle weakness is uncommon.
• Giddiness: Patient may present with an episode of giddiness because of vertebro-basilar syndrome.
There is loss of normal cervical lordosis and limitation in neck movements. There may be tenderness over the lower cervical spine or in the muscles of the para-vertebral region (myalgia).
The upper limb may have signs suggestive of nerve root compression – usually that of C6, root involvement.
Motor weakness is uncommon. The lower limbs must be examined for signs of early cord compression (e.g. a positive Babinski reflex etc.)
X-rays of the cervical spine (AP and lateral) are sufficient in most cases. Following radiological features may be present.
• Narrowing of intervertebral disc spaces most commonly between C5-C6).
Osteophytes at the vertebral margins, anteriorly and posteriorly.
X-Ray of the cervical spine, lateral view showing cervical Spondylosis ( note the lipping of C5-C6 vertebrae.
• Narrowing of the intervertebral foramen in cases presenting with radicular symptoms, may be best seen on oblique views.
The diseases to be considered in differential diagnosis of cervical spondylosis are:
(i) other causes of neck pain such as infection, tumours and cervical disc prolapse.
(ii) other causes of upper limb pain like Pancoast tumour, cervical rib, spinal cord tumours, carpal tunnel syndrome etc.
Principles of treatment: The symptoms of cervical spondylosis undergo spontaneous remissions and exacerbations.
Treatment is aimed at assisting the natural resolution of the temporarily inflamed soft tissues.
During the period of remission, the prevention of any further attacks is of utmost importance, and is done by advising the patient regarding the following:
a) Proper neck posture: Patient must avoid situations where he has to keep his neck in one position for a long time. Only a thin pillow should be used at night.
b) Neck muscle exercises: These help in improving the neck posture.
During an episode of acute exacerbation, the following treatment is required:
Rest to the neck in a cervical collar
Traction to the neck if there is stiffness
Anti-emetics, if there is giddiness
In an exceptional case, where the spinal cord is compressed by osteophytes, surgical decompression may be necessary.