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Cervical spondylosis (neck arthritis)


Cervical spondylosis is a condition characterised by degeneration of the discs and vertebrae at the top of the spinal column. This degenerative process is a normal part of aging. Cervical spondylosis is a form of arthritis and a common cause of neck pain symptoms in older people.

In New Zealand it is estimated that cervical spondylosis affects up to 50% of people over the age of 50 years and at least 70% of people over the age of 75 years.   The condition may also be referred to as cervical osteoarthritis.

General information and causes

The spinal column is made up of 24 individual vertebrae and 9 fused vertebrae. The spinal cord runs through a large central canal formed by the vertebrae. Nerves branch from the spinal cord through small openings between the vertebrae. The seven vertebrae at the top of the spinal column are known as the cervical vertebrae, the 12 vertebrae in the middle of the back are known as the thoracic vertebrae and the 5 vertebrae in the lower back are known as the lumbar vertebrae. The 9 fused vertebrae below the lumber vertebrae are collectively known as the sacrum.

Between each individual vertebra are strong discs with a fibrous, outer layer and an inner core filled with a gel-like tissue which cushion the vertebrae and allow for movement. They also protect the nerves and blood vessels between the vertebrae.

As we age, these discs shrink, flatten and become less flexible. This reduces the cushioning effect between the vertebrae and causes the spine to become less stable. In response to the shrinking of the discs the vertebrae may develop bony growths called bone spurs or osteophytes. These degenerative changes can irritate nearby muscles, ligaments and nerves. When this process occurs in the cervical vertebrae it is referred to as cervical spondylosis.

Cervical spondylosis can cause the neck to become more vulnerable to injuries such as strained ligaments and muscles. As the cervical spine becomes unstable the position and alignment of the discs and vertebrae may shift. This may allow the vertebrae to rub together, further adding to their degeneration.

Degeneration of the vertebrae and discs in the cervical spine is a normal part of ageing. Cervical spondylosis is diagnosed where the degree of degeneration is more severe, and the symptoms more problematic, than would be expected as part of the normal ageing process. 

Signs and symptoms

Symptoms of cervical spondylosis can range from being mild to very severe. The most common symptom is neck pain, which may spread through the base of the neck and the shoulders. The pain may come and go, or may be continuous. The neck may feel stiff, and sudden movements may cause or worsen pain. Headaches are also common.

Compression of the root of the nerves between the vertebrae can cause symptoms that include an aching, burning, tingling pain in the neck, which spreads towards one or both shoulders, down the upper part of the back between the shoulder blades, or down the arms. This is known as cervical radiculopathy.

Cervical spondylosis can also cause narrowing of the canal through which the spinal cord travels, known as spinal stenosis. When this narrowing compresses the spinal cord it is known as cervical myelopathy. Over time this compression can reduce the flow of blood and nutrients to the spinal cord, causing damage. Symptoms of cervical myelopathy can include:

  • Weakness of the legs or difficulty walking.
  • Weakness, pins and needles and loss of dexterity in the arms and hands.
  • Loss of feeling in the arms and/or legs.
  • Disturbance of normal function of bladder or bowel (an uncommon symptom which may occur in the later stages of the condition). 

Cervical myelopathy tends to develop slowly and it is estimated that it affects fewer than 5% of people with cervical spondylosis. 

Diagnosis

In diagnosing cervical spondylosis the doctor will ask the patient about their symptoms and medical history, and perform a physical examination. The patient may then have one or more of the following tests to confirm the diagnosis and pinpoint the location of the problem, particularly if surgery is contemplated:

  • X-rays to show the general condition of the vertebrae.
  • Myelogram – a specialised x-ray which use dye to highlight the spinal cord and nerves.
  • Magnetic Resonance Imaging (MRI) - scans that produce detailed images of soft-tissue.
  • Computerised Tomography (CT) - scans that show the vertebrae in detail. This can be combined with the myelogram.
  • Electromyographic (EMG) - studies to measure nerve function. 

Treatment

Treatment depends on the nature and severity of the symptoms experienced. In most cases conservative, non-surgical treatment is recommended.

Conservative treatment begins with rest – either by restricting activities or by resting in bed. If rest is not successful in relieving symptoms, then immobilisation with a neck brace for a period of time may be recommended.

Physiotherapy is often recommended. This usually involves treatment with heat, postural correction and exercises to strengthen neck muscles and preserve flexibility.

Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) may be recommended for pain relief and to reduce inflammation. Occasionally corticosteroid or muscle relaxant medications may also be prescribed. If pain is ongoing and severe, a particular antidepressant medication that is effective in treating pain may be prescribed.

For very severe pain, treatment with pain relieving medications injected directly around the spinal cord in the cervical spine may be recommended. This form of treatment should not be used on a long term basis.

Alternative treatment such as acupuncture, massage and naturopathy may prove effective in relieving symptoms for some people.

When medical treatment is not effective at managing the symptoms of the condition, surgery may be recommended. Surgery is not usually recommended for neck pain alone, but may be suggested when cervical radiculopathy or cervical myelopathy is present. The type of surgery performed will depend on each individual case. However, the overall goal of surgery is to alleviate symptoms by relieving pressure on the nerve root, spinal cord and blood vessels, and stabilising the spine. 

References

Anderson, K.N., Anderson, L.E. & Glanze, W.D. (eds.) (2006) Mosby’s medical, nursing, & allied health dictionary (6th ed.) St. Louis: Mosby -Year Book, Inc. 
Barrett, J. (2006) Cervical Spondylosis. The Gale Encyclopaedia of Medicine. Third Edition. Jacqueline L. Longe, Editor. Farmington Hills, MI. Thompson Gale. 
MedicineNet (2012) Degenerative disc disease and sciatica. Foothill Ranch MedicineNet.Inc
http://www.medicinenet.com/degenerative_disc/article.htm

Last reviewed – July 2013 

 

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