Cervical Spondylosis

Cervical Spondylosis, also called cervical osteoarthritis or neck arthritis, it is a common condition affecting the spinal disks in your neck.

It results due to age-related wear and tear of the cartilage and bones found in your neck.

Older people with this condition typically present symptoms like numbness, weakness in arms or legs, pain and stiffness in the neck and bone overgrowths. Majority of the people above 60 have cervical spondylosis.

There are various surgical and nonsurgical treatments available, the selection of which depends upon severity of the symptoms.

Many people with cervical spondylosis may remain unaware of the condition as it may not produce any symptoms. If the symptoms become apparent, they may appear gradually or all of a sudden. The common signs and symptoms are pain and stiffness in the neck.

In some people, cervical spondylosis can cause narrowing of spinal canal. If this happens, the spinal cord and nerve roots may be compressed that can result into symptoms like:

• Tingling, numbness and weakness in arms, hands, legs or feet
• Lack of coordination and problem with walking
• Urinary incontinence (loss of bladder control)
• Fecal incontinence (loss of bowel control)

When to see a doctor

Consult your doctor if you experience a sudden numbness or weakness, or loss of bladder or bowel control.

Age-related wear and tear of the cartilage and bones found in your neck is the main cause of Cervical spondylosis.

These inevitable wear and tear include:

• Dehydrated disks: The vertebrae of your spine consist of cushion-like disks between them. The disks absorb shocks that occur due to various natural activities. By the time you reach 40, most of your spinal disks begin drying out and shrinking, which causes bones to rub against each other.
• Herniated disks: Another effect of aging is that it causes weakening of the disk exterior that leads to bulging (herniated) disks. The bulges can compress spinal cord and nerve roots.
• Bone spurs: In an attempt to make up for disk degeneration, the spine may produce extra bones, which can compress the spinal cord and nerve roots.
• Stiff ligaments: Ligaments are the cords of tissue that connect your spinal bones together. With aging, your ligaments may stiffen causing limited neck movement.

Your doctor may refer you to a physical therapist or an orthopedist (a doctor specializing in spine disorders) for making a diagnosis of Cervical spondylosis.

How to prepare yourself for the visit

• Getting prepared for the visit can optimize the therapy and help make the visit more fruitful.
• List out all the symptoms
• Write down your key medical information.
• Mention if you have a family history of this or similar condition.
• Write down the names of all your medications, vitamins or supplements.
• Make a list of the questions to ask your doctor.

Some typical question can be:

• What could be the possible cause/s of my symptoms?
• What are treatment options for my condition? Which one do you think will work the best for me?
• What are the tests do I need to take?

What your doctor wants to know

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor.

Your doctor might ask you typical questions like:

• Can you locate your pain?
• Did you suffer similar pain in the past?
• Do you have a full control over your bladder or bowel control?
• Are there any tingling sensations or weakness in your arms, hands, legs or feet?
• Have you recently experienced any difficulty walking?
• What are your occupation, hobbies and recreational activities?
• Have you suffered a whiplash or another neck injury in the past?

Your doctor will most probably start the diagnosis with physical examination followed by other tests to identify the condition.

Your doctor will:

• Check the range of motion in your neck to determine flexibility of the neck and
• Test your reflexes and muscle strength to assess if your spinal nerves or spinal cord are affected
• Watch you walk to see if there is balance and coordination problems possibly caused by spinal compression

Imaging tests: These tests are carried out to obtain detailed and quantitative information about the condition. The results of these tests can be interpreted to confirm if you have the condition which in turn will be beneficial to determine appropriate treatment.

Your doctor might recommend:

• Neck X-ray: A neck X-ray can detect if bone abnormalities such as bone spurs are responsible for cervical spondylosis.
• CT scan: CT scan uses several X-ray images to produce cross-sectional images of the bones.
• MRI: MRI uses powerful radio waves and magnets to produce detailed images of the bones. An MRI can locate the areas of nerve compression.
• Myelography: It is a type of radiographic examination that detects spinal cord abnormalities such as spinal cord injury. It involves injecting a tracer dye into the spinal canal followed by detailed X-ray or CT imaging.
• Nerve function tests: These tests are carried out to determine if there is any problem in the nerve transmission or conduction.

Nerve function tests include:

• Electromyography (EMG): An EMG measures nerve’s electrical activity during signal transmission to muscles.
• Nerve conduction study: This test measures the strength and speed of nerve signals as they travel along certain areas of the body. It involves placing electrodes your skin of the concerned area.

The treatment for cervical spondylosis is determined by severity of your signs and symptoms. It is aimed at relieving pain, helping you continue your usual activities and avoiding complications like permanent injury to the spinal cord and nerves.

Medications

• Nonsteroidal anti-inflammatory drugs (NSAIDS): Your doctor may prescribe high doses of NSAIDS such as ibuprofen or naproxen to relieve pain and inflammation.
• Prescription pain relievers: Your doctor might prescribe oxycodone, a morphine like analgesic available only on a prescription.
• Corticosteroids: Pain reduction may also be achieved by oral administration of steroids such as prednisone. If this does not help, you may have to take steroid injections.
• Muscle relaxants: To treat neck stiffness, your doctor may prescribe drugs like cyclobenzaprine and methocarbamol.
• Anti-seizure medications: Neuropathic pain may respond to certain anti-seizure agents like gabapentin and pregabalin.
• Antidepressants: Certain depression treating drugs are found to alleviate the pain associated with cervical spondylosis.

Therapy

You may consult a physical therapist to learn exercises that strengthen your neck and shoulder muscles. Traction is found to benefit some people with cervical spondylosis. A traction can help widen the spinal canal and release stress on the nerve roots.

• Acupuncture: Talk to your doctor if acupuncture might help you mitigate the pain. Get help from a licensed acupuncture practitioner only.
• Surgery: In an event when conservative treatments do not provide you the expected results or the neurological signs and symptoms such as weakness in your arms or legs show no improvement, a surgery can be the ultimate option. A surgery helps widen the spinal canal thus providing more space for your spinal cord and nerve roots. The surgery can be done to:
• Remove a herniated disk or bone spurs
• Remove part of a vertebra (Spinal fusion): It involves “welding” spine segments by using bone graft

Lifestyle modifications are necessary in order to cope with Cervical spondylosis.

If cervical spondylosis is mild, you may consider the following:

• Regular exercise: Physical activity, of any type, boosts recovery. Likewise, daily walks may reduce neck and low back pain.
• Over-the-counter (OTC) pain relievers: Non-prescription pain relievers like Ibuprofen, naproxen or acetaminophen often provide expected pain relief.
• Heat or ice: You may use hot or cold compress neck can to reduce pain.
• Soft neck brace: Using a soft neck brace can immobilize the neck and thus provide rest to the neck muscles. Be warned that long term use of the brace can cause weakness and atrophy in the neck muscles.

There are several risks and complications associated with Cervical spondylosis.

Risks

• Age: Age related wear and tear of the neck bones and cartilage is the cause of cervical spondylosis.
• Occupation: People who have to be in awkward positioning or need repetitive neck movements as a part of their profession may be at greater risk of cervical spondylosis.
• Neck injuries: A history of neck injury may increase your risk of developing cervical spondylosis.
• Genetic factors: Sometimes, your genes might be responsible for increasing your risk of the condition.
• Smoking: An association between smoking and increased neck pain has been observed.

Complications

If your spinal cord or nerve roots become severely compressed as a result of cervical spondylosis, the damage can be permanent.