Cervical spondylosis: Causes, symptoms, and prevention

Cervical spondylosis

Cervical spondylosis, colloquially known as neck arthritis, is a degenerative condition characterized by the wear and tear of the intervertebral discs in the cervical spine. This degeneration is primarily attributed to the natural aging process, leading to a progressive loss of the structural and functional integrity of the cervical discs.

Epidemiology

Cervical spondylosis is a ubiquitous condition in the geriatric population. Studies indicate that the majority of individuals aged 60 and above exhibit radiographic evidence of cervical spondylosis, although many remain asymptomatic. The asymptomatic nature of this condition in a significant portion of the affected population underscores the importance of differentiating between age-related anatomical changes and clinically significant pathology.

Causes and risk factors of cervical spondylosis

A. Aging

• Degeneration of Disks and Joints: As individuals age, the cervical discs and facet joints undergo wear and tear. This degenerative process can lead to the formation of osteophytes (bone spurs) and narrowing of the spinal canal.
• Loss of Water Content in the Spinal Disks: With advancing age, the spinal discs lose hydration, reducing their flexibility and shock-absorbing capabilities. This dehydration can result in disc thinning and reduced intervertebral space.

B. Previous neck injuries

• Traumatic events, such as whiplash or direct blows to the neck, can accelerate the degenerative process. These injuries might cause immediate damage or introduce instability that, over time, leads to spondylosis.

C. Genetic factors

• There's evidence to suggest that cervical spondylosis may run in families. Individuals with a family history of neck pain or spondylosis might be at a heightened risk.

D. Occupational factors

• Repetitive Neck Motions: Jobs that require frequent neck movements, such as looking up or down for extended periods, can stress the cervical spine.
• Awkward Positioning: Occupations that demand holding the neck in an awkward position for prolonged durations, like painting ceilings or certain surgical specialties, can contribute to wear and tear.

E. Other conditions

• Past Surgeries: Previous surgeries in the cervical region can alter the biomechanics of the spine, potentially leading to degenerative changes in adjacent segments.
• Rheumatoid Arthritis: This autoimmune disorder can cause inflammation of the joints in the neck, accelerating degenerative changes.
• Other Systemic Conditions: Certain conditions, like infections or tumors, can also predispose the cervical spine to degenerative changes.

Understanding these risk factors is crucial for both preventive strategies and therapeutic interventions. Regular check-ups and early intervention can mitigate the progression of cervical spondylosis and improve the quality of life for affected individuals.

Symptoms of cervical spondylosis

A. Neck Pain and Stiffness

• This is the most common symptom. Pain might be localized to the neck or may radiate down the arms. Stiffness often worsens after prolonged periods of inactivity, like after waking up in the morning.

B. Headaches

• These typically originate at the back of the head and can radiate forward. Often termed as "occipital headaches," they are due to referred pain from the cervical spine.

C. Muscle Spasms

• Sudden, involuntary contractions of the neck muscles can occur, leading to pain and sometimes limiting the range of motion.

D. Grinding or Popping Noise/Sensation when the Neck is Turned

• Medically termed as "crepitus," this sensation occurs due to the movement of degenerated or misaligned vertebrae and discs against each other.

E. Weakness in Arms or Legs

• If the degeneration leads to nerve compression, it can result in muscle weakness. This is more concerning as it indicates more severe nerve involvement.

F. Numbness or Tingling in Shoulders, Arms, or (rarely) Legs

• Nerve compression or irritation can also lead to sensory disturbances, such as numbness, tingling, or even burning sensations. While it's more common in the arms and shoulders, severe compression of the spinal cord can affect the legs as well.

It's essential to recognize that while these symptoms can be indicative of cervical spondylosis, they can also be seen in other conditions. Proper diagnosis through clinical examination and imaging is crucial to differentiate cervical spondylosis from other potential causes.

Complications of cervical spondylosis

A. Cervical Myelopathy

• Cervical myelopathy refers to the dysfunction of the spinal cord due to direct compression. It is one of the most severe complications of cervical spondylosis.
• Causes: The spinal cord may be compressed by bulging discs, osteophytes (bone spurs), thickened ligaments, or a combination of these factors.
• Symptoms:
  • Difficulty in fine motor tasks, such as buttoning a shirt.
  • Unsteady gait or difficulty walking.
  • Loss of bowel or bladder control in advanced cases.
  • Numbness or tingling in the hands, fingers, or legs.
  • Muscle weakness, especially in the arms and hands.
• Management: Cervical myelopathy often requires surgical intervention to decompress the spinal cord and prevent further neurological deterioration.

B. Cervical Radiculopathy

• Cervical radiculopathy arises when a nerve root in the cervical spine becomes compressed or irritated. This can lead to neurological symptoms in the areas the nerve supplies.
• Causes: Nerve root compression can be due to herniated discs, osteophytes, or thickened ligaments.
• Symptoms:
  • Sharp, shooting pain radiating down the arm.
  • Numbness or tingling in specific areas of the arm or hand.
  • Muscle weakness in the affected arm.
  • Deep, aching pain in the neck or shoulder region.
• Management: Treatment can range from conservative measures like physical therapy and medications to surgical interventions, depending on the severity and duration of symptoms.

Both complications underscore the importance of early diagnosis and intervention in cervical spondylosis. Left untreated, these complications can lead to permanent neurological deficits.

Complications of cervical spondylosis

A. Cervical myelopathy

• Cervical myelopathy refers to the dysfunction of the spinal cord due to direct compression. It is one of the most severe complications of cervical spondylosis.
• Causes: The spinal cord may be compressed by bulging discs, osteophytes (bone spurs), thickened ligaments, or a combination of these factors.
• Symptoms:
  • Difficulty in fine motor tasks, such as buttoning a shirt.
  • Unsteady gait or difficulty walking.
  • Loss of bowel or bladder control in advanced cases.
  • Numbness or tingling in the hands, fingers, or legs.
  • Muscle weakness, especially in the arms and hands.
• Management: Cervical myelopathy often requires surgical intervention to decompress the spinal cord and prevent further neurological deterioration.

B. Cervical radiculopathy

• Cervical radiculopathy arises when a nerve root in the cervical spine becomes compressed or irritated. This can lead to neurological symptoms in the areas the nerve supplies.
• Causes: Nerve root compression can be due to herniated discs, osteophytes, or thickened ligaments.
• Symptoms:
  • Sharp, shooting pain radiating down the arm.
  • Numbness or tingling in specific areas of the arm or hand.
  • Muscle weakness in the affected arm.
  • Deep, aching pain in the neck or shoulder region.
• Management: Treatment can range from conservative measures like physical therapy and medications to surgical interventions, depending on the severity and duration of symptoms.

Both complications underscore the importance of early diagnosis and intervention in cervical spondylosis. Left untreated, these complications can lead to permanent neurological deficits.

Treatment options for cervical spondylosis

A. Conservative treatments

• Physical Therapy:
  • Tailored exercises to strengthen neck muscles and improve flexibility.
  • Postural training to ensure proper alignment and reduce strain on the neck.
  • Modalities like heat or cold therapy, ultrasound, or electrical stimulation to alleviate pain.
• Medications:
  • Pain Relievers: Over-the-counter pain relievers like acetaminophen or NSAIDs (e.g., ibuprofen) can help reduce pain and inflammation.
  • Muscle Relaxants: Drugs like cyclobenzaprine or methocarbamol can help relieve muscle spasms.
  • Corticosteroid Injections: Direct injection into the neck to reduce inflammation and pain around the nerve roots.
• Neck Brace or Collar:
  • Provides support and limits neck movement, allowing muscles to rest and heal.
  • Typically used for short durations to prevent muscle weakening.

B. Surgical treatments

• Decompression:
  • Removing tissue that's pressing on a nerve structure, which can be a part of a disc, a bone spur, or ligament.
  • Procedures include anterior cervical discectomy and corpectomy.
• Fusion:
  • Joining two vertebrae together to limit their movement and stabilize the spine.
  • Often done after decompression to maintain spinal stability.
  • Bone grafts, plates, screws, or cages might be used to facilitate fusion.

C. Alternative therapies

• Acupuncture:
  • Traditional Chinese medicine technique involving the insertion of thin needles into specific points on the body.
  • Believed to stimulate the body's natural painkillers and increase blood flow.
• Chiropractic Care:
  • Spinal manipulation and adjustments to improve spinal function and alleviate pain.
  • Should be approached with caution, especially in cases with significant spinal cord or nerve root compression.
• Massage:
  • Helps relax tense muscles in the neck and shoulder region.
  • Can improve blood flow and provide pain relief.

It's essential to note that the best treatment approach often depends on the severity of the symptoms, the specific anatomical abnormalities present, and the patient's overall health and preferences. Regular follow-up with a healthcare provider is crucial to monitor the condition and adjust the treatment plan as necessary.

Prevention of cervical spondylosis

A. Ergonomics and Posture

• Workstation Setup: Ensure that computer monitors are at eye level, keyboards and mice are positioned so the wrists are neutral, and chairs provide proper lumbar support.
• Proper Sitting: Avoid slouching. Use a chair with good neck and back support. Take regular breaks if sitting for extended periods.
• Sleeping Position: Use a supportive pillow that keeps the neck in a neutral position. Avoid sleeping on the stomach, which can strain the neck.

B. Regular Exercise

• Cardiovascular Activities: Engaging in activities like walking, swimming, or cycling can help maintain overall health and improve neck flexibility.
• Flexibility: Incorporate stretching into your routine to maintain the range of motion in the neck and shoulders.
• Balance and Coordination: Activities like yoga or tai chi can enhance body awareness, balance, and coordination, reducing the risk of injuries that might strain the neck.

C. Avoiding Repetitive Strain

• Breaks: If your job or activity involves repetitive neck movements or prolonged neck positioning, take frequent breaks to relax and stretch the neck.
• Variation: Rotate tasks to avoid maintaining the same neck position or doing the same motion for extended periods.

D. Neck strengthening exercises

• Isometric Exercises: Push your hand against your forehead and resist the motion with your neck muscles. Repeat in all directions.
• Resistance Band Exercises: Using a resistance band, perform flexion, extension, and lateral bending against the resistance.
• Chin Tucks: Sit or stand with a good posture. Tuck your chin slightly towards your chest to strengthen the deep neck flexors. This exercise also promotes a neutral spine position.

Incorporating these preventive measures can significantly reduce the risk of developing cervical spondylosis or alleviate the progression of existing conditions. It's always a good idea to consult with a physical therapist or healthcare provider to ensure exercises and postures are done correctly.

Cervical spondylosis, a common degenerative condition of the neck's vertebrae and discs, underscores the critical importance of early diagnosis and intervention. While treatments exist to manage its symptoms, a proactive approach emphasizing prevention, proper ergonomics, and a healthy lifestyle remains paramount. As we age, awareness and proactive measures can significantly reduce the impact of this condition, ensuring a life marked by mobility and well-being.