Cervical spondylosis

Definition

Cervical spondylosis is a disorder in which there is abnormal wear on the cartilage and bones of the neck (cervical vertebrae).

See also:

• Neck pain
• Herniated disk
• Spinal stenosis

Alternative Names

Cervical osteoarthritis; Arthritis - neck; Neck arthritis

Causes, incidence, and risk factors

Cervical spondylosis is caused by chronic wearing away (degeneration) of the cervical spine, including the cushions between the neck vertebrae (cervical disks) and the joints between the bones of the cervical spine. There may be abnormal growths or "spurs" on the bones of the spine (vertebrae).

These changes can, over time, press down on (compress) one or more of the nerve roots. In advanced cases, the spinal cord becomes involved. This can affect not just the arms, but the legs as well.

The major risk factor is aging. By age 60, most women and men show signs of cervical spondylosis on x-ray. Other factors that can make a person more likely to develop spondylosis are:

• Past neck injury (often several years before)
• Severe arthritis
• Past spine surgery

Symptoms

Symptoms often develop slowly over time, but may start suddenly.

More common symptoms are:

• Neck pain (may radiate to the arms or shoulder)
• Neck stiffness that gets worse over time
• Loss of sensation or abnormal sensations in the shoulders, arms, or (rarely) legs
• Weakness of the arms or (rarely) legs
• Headaches, particularly in the back of the head

Less common symptoms are:

• Loss of balance
• Loss of control over the bladder or bowels (if spinal cord is compressed)

Signs and tests

Examination often shows limited ability to bend the head toward the shoulder and rotate the head.

Weakness or loss of sensation can be signs of damage to specific nerve roots or to the spinal cord. Reflexes are often reduced.

The following tests may be done:

• CT scan or spine MRI
• Spine or neck x-ray
• EMG
• X-ray or CT scan after dye is injected into the spinal column (myelogram)

Treatment

Even if your neck pain does not go away completely, or it gets more painful at times, learning to take care of your back at home and prevent repeat episodes of your back pain can help you avoid surgery.

Symptoms from cervical spondylosis usually stabilize or get better with simple, conservative therapy, including:

• Nonsteroidal anti-inflammatory medications (NSAIDs)
• Narcotic medicine or muscle relaxants
• Physical therapy to learn exercises to do at home
• Cortisone injections to specific areas of the spine
• Various other medications to help with chronic pain, including phenytoin, carbamazepine, or tricyclic antidepressants such as amitriptyline

If the pain does not respond to these measures, or there is a loss of movement or feeling, surgery is considered. Surgery is done to relieve the pressure on the nerves or the spinal cord.

See also:

• Foraminotomy
• Laminectomy
• Spinal fusion

Expectations (prognosis)

Most patients with cervical spondylosis will have some long-term symptoms. However, they respond to non-surgical treatments and do not need surgery.

Complications

• Chronic neck pain
• Inability to hold in feces (fecal incontinence) or urine (urinary incontinence)
• Progressive loss of muscle function or feeling
• Permanent disability (occasional)

Calling your health care provider

Try home treatments, such as the use of a cervical collar (which you can buy at pharmacies) and over-the-counter pain medications.

Call your health care provider if:

• The condition becomes worse
• There are signs of complications
• You develop new symptoms (such as loss of movement or sensation in an area of the body).

Prevention

Many cases are not preventable. Preventing neck injury (such as by using proper equipment and techniques when playing sports) may reduce your risk.

References

Feske SK, Cochrane TL. Degenerative and compressive structural disorders. In: Goetz CG. Goetz: Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 29.

Polston DW. Cervical radiculopathy. Neurol Clin. 2007;25:373-385.

Devereaux M. Neck Pain. Med Clin North Am. 2009;93:273-284.