Cervical Spondylosis

Basic Anatomy

The back of the neck includes the cervical spine and the muscles and ligaments that surround and support it. The cervical spine is made up of seven bones called vertebrae. The first two are slightly different to the rest, as they attach the spine to the skull and allow the head to turn from side to side. The lower five cervical vertebrae are roughly cylindrical in shape - a bit like small tin cans - with bony projections.

The sides of the vertebrae are linked by small facet joints. Between each of the vertebrae is a 'disc'. The discs are made of a tough fibrous outer layer and a softer gel-like inner part. The discs act like 'shock absorbers' and allow the spine to be flexible.

Strong ligaments attach to adjacent vertebrae to give extra support and strength. Various muscles attached to the spine enable the spine to bend and move in various ways.

The spinal cord, which contains nervous tissue carrying messages to and from the brain, is protected by the spine. Nerves from the spinal cord come out from between the vertebrae in the neck to take and receive messages to the neck and arms. A major blood vessel called the vertebral artery also runs alongside the vertebrae to carry blood to the rear (posterior) part of the brain.

What is cervical spondylosis?

Cervical spondylosis is an age-related degeneration ('wear and tear') of the bones (vertebrae) and discs in the neck. To an extent, we all develop some degeneration in the vertebrae and discs as we become older. It tends to start sometime after the age of about 30.

One feature of the degeneration is that the edges of the vertebrae often develop small, rough areas of bone called osteophytes. Also, over many years, the discs become thinner. This degeneration is a normal ageing process which can be likened to having 'wrinkles in the spine'. In many people, the degeneration does not cause any symptoms. For example, routine X-rays of the neck will show these features (osteophytes and disc thinning) in many people who do not have any symptoms.

However, in some people, the nearby muscles, ligaments, or nerves may become irritated or 'pressed on' by the degenerative changes. So, cervical spondylosis often causes no problems but can be a cause of neck pain, particularly in older people

What are the symptoms of cervical spondylosis?

If symptoms develop, they can range from mild to severe. Symptoms may include:

·       Pain in the neck:

·       This may spread to the shoulders and base of the skull. Movement of the neck may make the pain worse.

·       The pain sometimes spreads down an arm to a hand or fingers. This is caused by irritation of a nerve which goes to the arm from the spinal cord in the neck.

·       The pain tends to come and go with flare-ups from time to time. You may have a flare-up of pain after unaccustomed use of your neck, or if you sprain a neck muscle or ligament.

·       However, a flare-up often develops for no apparent reason. Some people develop chronic (persistent) pain.

·       Some neck stiffness, particularly after a night's rest.

·       Headaches may occur. The headaches often start at the back of the head just above the neck and travel over the top to the forehead.

·       You may develop 'pins and needles' in part of an arm or hand. This symptom is caused by irritation of a spinal nerve as it leaves the bony (vertebral) area. However, do tell a doctor if loss of feeling (numbness) or weakness develops in a part of a hand or arm. These symptoms suggest more pressure on a nerve. This is called a 'cervical radiculopathy'.

·       sometimes, clumsiness of a hand, problems with walking, or problems with bladder function occur when pressure from a worn bone (vertebra) or disc damages the spinal cord. This is called 'cervical myelopathy'. Again, it is important to report these symptoms to a doctor.

What are the treatments for cervical spondylosis ????

Medicines

Painkillers are often helpful. Should not be used for long time…..

Physiotherapy

1.     Cervical Traction

2.     IFT to neck

3.     Hot packs

4.     TENS to upper limb

5.     Manual therapy

Other treatments

Some other treatments which may be advised include:

·       A good posture may help. Check that your sitting position at work or at the computer is not poor (that is, not with your head flexed forward with a stooped back). Sit upright. Yoga, Pilates and the Alexander Technique all improve neck posture; however, their value in treating neck pain is uncertain.

·       A firm supporting pillow seems to help some people when sleeping. Try not to use more than one pillow.

Pain Block – can be used intermediate pathway for pain relief before surgery if pain doesn’t relives with the help of medicines…

Indications for surgery-  ( Red Flags )

1.       Rarely required

2.       Failed conservative trial for longer duration

3.       Was better for some time after pain block and symptoms again recurred

4.       Weakness in upper limbs

5.       Sever tingling and numbness upper limbs with large disc prolapse in MRI

6.       Difficulty in walking , loss of balance while walking

7.       Difficulty in passing urine and motion

Surgical Options available….

Cervical Fusion Surgery

Cervical Disc replacement surgery

             

Disc replacement surgery

Cervical myelopathy

This occurs when there is pressure on or damage to the spinal cord itself. Again, cervical spondylosis is a common cause of this condition, as the degenerative changes to the vertebra can narrow the canal through which the spinal cord passes. A prolapse of a cervical disc can also cause myelopathy if the prolapse is into the central canal of the vertebra. This may happen suddenly or develop over a period of time. There are various other rare causes of cervical myelopathy. For example, a tumour or infection that affects this part of the spinal cord.

As the spinal cord is made up of groups of nerve fibres carrying messages to the brain from the rest of the body, pressure on these nerves in the neck region can produce symptoms from several parts of the body.

The symptoms of a cervical myelopathy may include:

·       Difficulties with walking. For example, the legs may feel stiff and clumsy.

·       Changes to the sensation of the hands. For example, it may be difficult to feel and recognise objects in the usual way and you may have a tendency to drop things.

·       Problems with your bladder. For example, you may experience problems with emptying your bladder, or incontinence.

·       Needs support while walking like a stick or walker

·       Eventually not able to walk and patient requires either wheelchair or stature..