Cervical Spondylosis

Are you suffering from neck pain?

Patient with Neck pain (Cervical spondylosis)

Cervical spondylosis (Neck pain) is one of the most common spine dysfunction, which is also referred to as cervical degenerative disease. Due to age as the prime trigger factor, it is mostly seen in the elderly people. According to the Journal of Disease-a-Month, approx. 20%-50% of adults suffer from neck pain every year, and a majority of them are caused by cervical spondylosis. Apart from the lumber spondylosis, it is one of the commonest medical issues, treated by the health care providers.

Diagram showing spine anatomy of Cervical spondylosis

Spine Anatomy

The spine is made up of 33 bones, called vertebrae, which are stacked one above the other. These bones connect to create a space (canal), which protects the spinal cord. The first seven vertebrae which begin at the base of the skull and neck comprise to form the cervical spine. Cervical spondylosis occurs in the cervical spine, the seven small vertebrae forming the neck.

Other parts of the spine are:

Spinal cord and spinal nerves:

These "electrical" cables travel through the spinal canal carrying signals (messages) between the brain and muscles. The nerve roots branch off from the spinal cord through openings in the vertebrae.

Intervertebral discs:

These are intervertebral discs flexible that are found between your vertebrae. They act as shock absorbers when you walk or run.The inter-vertebral discs are flat, round and about half an inch thick.

The inter-vertebral discs consist of two components:

  • Annulus fibrosus: It is the flexible outer ring, hard disk.
  • Nucleus pulposus: It is the soft, gelatinous center of the disc.
  • Causes of Cervical Spondylosis

    Diagram showing herniated disk

    Cervical spondylosis occurs mainly due to the degenerative changes that occur in the spine with increased age. These changes are normal, which happen with everybody. In fact, almost half of all middle-aged and older have worn discs that do not cause painful symptoms.

    Disc degeneration and bone spur

    As spinal discs age, they lose height and begin to swell (bulge). They also lose water content, begin to dry and, in turn, become weak. This problem makes the settling or collapse of the disc space and loss of disc space height.

    As the facet joints progress, pressure also begins to degenerate and develop arthritis, similar to the one that happen in the articulation of the hip or knee. Articular cartilage smooth, slick that covers and protects the joints wears away.

    If the cartilage is completely worn, it can result in bone rubbing on bone. To compensate for the lost cartilage, your body may respond by growing new bone in the facet joints to help keep the vertebrae. Over time, this bone overgrowth - called bone spurs - can reduce the space for the nerves and the spinal cord to pass through (stenosis).

    Risk factors

    Age is the most common risk factor for neck pain or cervical spondylosis. The condition is very common in patients who are middle-aged and older.

    Other factors that may increase the risk of developing cervical spondylosis or neck pain are:

  • Genetics: a family history of neck pain and spondylosis
  • Smoking: clearly linked to increased neck pain
  • Occupation: jobs with a lot of movement of the neck and repetitive work.
  • Depression or anxiety
  • Old injury or trauma to the neck
  • Symptoms of Cervical Spondylosis

    In most of the cases, cervical spondylosis causes no symptoms. When symptoms occur, they usually include:

    Pain and stiffness in the neck, which can range from mild to severe. Sometimes it exacerbated by looking up or looking down for a long time, or activities in which the neck is held in one position for an extended period of time such as driving or reading a book. The pain is usually relieved by rest or lying down.

    Other symptoms may include:
  • Headache, mostly in the back of the head
  • Grinding or popping noise or feeling when the neck is turned
  • In some cases, cervical spondylosis results in a narrowing of the space required for the spinal cord or nerve roots. If this occurs, symptoms may include numbness and weakness in the arms, hands, and fingers.
  • Difficulty in walking, loss of balance or weakness in the hands or legs
  • Muscle spasms in the neck and shoulders
  • Diagnosis of Cervical Spondylosis:

    Your doctor might suggest some tests to help confirm the diagnosis of cervical spondylosis.

    X-Ray showing degenerative changes of cervical spine

    X-rays:

    It provides images of dense structures, such as bone and joint space. An X-ray shows the alignment of the bones along its neck. It can also reveal degenerative changes in the cervical spine, such as loss of disc height and the presence of bone spurs.

    Magnetic resonance imaging (MRI) scans:

    These studies create better images of soft tissues in the body, such as muscles, discs, nerves and spinal cord. An MRI can help determine if your symptoms are caused by damage to the soft tissues, such as a bulging or herniated disc.

    Computed tomography (CT):

    More detailed than a simple x-ray, a CT scan can help your doctor better see your spinal canal and any bone spurs.

    Myelogram:

    This is a special type of CT scan. In this procedure, a dye is injected into the spinal canal to make the spinal cord and nerve roots more clearly visible.

    Treatment of Cervical Spondylosis:

    The aim of the cervical spondylosis treatment is to provide pain relief, prevent the risk of permanent damage, and help the patients lead a quality life. Usually, the non-operative treatments work excellent in this condition.

    Medications

    Muscle relaxants:

    Drugs such as cyclobenzaprine or carisoprodol can also be used in the case of painful muscle spasms.

    Non-steroidal anti-inflammatory drugs:

    Often prescribed with acetaminophen, a drug like Ibuprofen, which is considered as the first-line of medicine for neck pain. This drug addresses both pain and swelling, and may be prescribed for a number of weeks.

    Acetaminophen:

    Mild pain is often relieved with acetaminophen. The goal of pharmacotherapy is to reduce pain and inflammation.

    None of the above medicines should be taken without consultation from an orthopedic specialist.

    Surgical management

    Surgery is not commonly recommended for cervical spondylosis and neck pain unless your doctor confirms that:

  • A spinal nerve is being pinched by a herniated disc or bone (cervical radiculopathy)
  • The spinal cord (cervical spondylotic myelopathy) is compressed
  • Patients with progressive neurological symptoms such as numbness, arm weakness, or falling, are more likely to be helped by surgery.

    Physiotherapy management in Cervical Spondylosis:

    Diagram of patient with cervical collar

    Physiotherapy is usually the first non-surgical treatment that your doctor might recommend. Specific exercises can help relieve pain, strengthen and stretch the muscles weakened or strained. In some cases, physiotherapy may include posture therapy or the use of traction to stretch the joints and muscles of your neck gently. Physiotherapy programs vary in length but usually last for 6-8 weeks. Typically, sessions are scheduled 2 to 3 times a week.

  • The patient is advised to use cervical collar in case of cervical spine and lumbar corset in lumbar spine.
  • Bed rest.
  • Static cervical and lumbar exercises.
  • Intermittent mechanical traction for 20 minutes daily.
  • Moist/heat therapy can relieve pain and muscle spasm.
  • SWD, US, MWD etc. to relieve chronic inflammation and pain.
  • Interferential therapy in cases of acute conditions.
  • Transcutaneous electrical nerve stimulator (TENS) can be given to relieve radicular pains.
  • Gentle mobilization techniques can be used to regain range of motion and to relieve stiffness.
  • Electrical stimulation:

    TENS unit may be issued to a patient for home use. E-stimulator is used to stimulate your muscles through variable intensities of electrical current.

    It helps to decrease muscle spasms and also act as a natural painkiller. TENS also drive out inflammation, herald healing properties, relax and re- educate the muscles which involved.

    Heat therapy:

    Physiotherapist uses different heating modalities to improve blood circulation to the target area because an increased blood flow brings more O2 and nutrients to that area. Blood is also needed to remove waste created by muscle spasms, and it also assist in decrease pain.

    Soft tissue manipulation:

    This technique targets spasms and chronic muscle tension and pain that perhaps build up through daily life stress. You could also have spasms or muscle tension because of strains or sprains.

    During physiotherapy the physiotherapist uses direct pressure and friction to try to release the tension in your soft tissues (ligaments, tendons, muscles).

    There is no specific way to prevent this condition. However, some lifestyle changes can delay the process of degeneration.

    Illustration of static cervical exercises

    Prevention of Cervical Spondylosis:

    The lifestyle changes include:

  • Regular strengthening and flexibility exercise for the muscles of the neck
  • Regular aerobic exercises such as running, swimming
  • Postural awareness to maintain good posture
  • Changes in the workplace to reduce the stress on the neck
  • Avoid smoking
  • Maintain healthy weight