Spondylosis

Cervical spondylosis is a common degenerative condition of the cervical spine. It is most likely caused by age-related changes and mechanical factors are prominent.

In cervical spondylosis, degenerative changes start in the intervertebral discs with osteophyte formation and involve adjacent soft tissue structures. Many people over 30 show similar abnormalities on plain radiographs of the cervical spine and hence boundary between normal ageing and disease is difficult to define. Even severe degenerative changes are often asymptomatic, but can lead to neck pain, stiffness, or neurological complications.

PRESENTING FEATURES OF CERVICAL SPONDYLOSIS

  • Pain aggravated by movement
  • Referred pain (occiput, between the shoulder blades, upper limbs)
  • Retro-orbital or temporal pain (from C1 and C2)
  • Cervical stiffness
  • Numbness, tingling, or weakness in upper limbs
  • Dizziness or vertigo
  • Poor balance
  • Rarely, syncope, migraine, pseudo-angina

SIGNS IN CERVICAL SPONDYLOSIS

  • Poorly localised tenderness
  • Limited range of movement (forward flexion, backward extension, lateral flexion, and rotation to both sides)
  • Minor neurological changes (unless complicated by myelopathy or radiculopathy)

Differential diagnosis of cervical spondylosis

  • Other non-specific neck problems—acute neck strain, postural neck ache, or whiplash
  • Fibromyalgia
  • Mechanical lesions—disc prolapse or diffuse idiopathic skeletal hyperostosis
  • Inflammatory disease—rheumatoid arthritis, ankylosing spondylitis, polymyalgia rheumatica
  • Metabolic diseases—Paget’s disease, osteoporosis, gout, pseudo-gout
  • Infections—osteomyelitis, tuberculosis
  • Malignancy—primary tumours, secondary deposits, myeloma

DIAGNOSIS

Cervical spondylosis is usually diagnosed on clinical grounds alone. Although pain is predominantly in the cervical region, it can be referred to a wide area, and is characteristically exacerbated by neck movements. Neurological change should always be sought in the upper and lower limbs, but objective changes occur only when spondylosis is complicated by myelopathy or radiculopathy, or when unrelated causes like disc prolapse, thoracic outlet obstruction, brachial plexus disease, malignancy, or primary neurological disease are present.

IMAGING

Most patients do not need further investigation, and the diagnosis is made on clinical grounds alone. Plain radiographs of the cervical spine may show a loss of normal cervical lordosis, suggesting muscle spasm, but most other features of degenerative disease are found in asymptomatic people and correlate poorly with clinical symptoms. Magnetic resonance imaging of the cervical spine is the investigation of choice if more serious pathology is suspected, as it gives detailed information about the spinal cord, bones, discs, and soft tissue structures. However, normal people can show important pathological abnormalities on imaging, so scans need to be interpreted with care.

Summary

Cervical spondylosis, also known as cervical osteoarthritis or neck arthritis, is a common age-related condition that affects the joints and discs in the neck. In most cases it can be managed with conservative treatments and a rehabilitative approach. Injection treatments can be used to facilitate a rehabilitative approach and help break the pain cycle in patients who fail to make progress with conservative management.

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