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Neck arthritis (cervical spondylosis)

 

Neck arthritis (cervical spondylosis) is a long-term condition caused by “wear and tear” to the bones and soft tissue at the top of the spinal column as we get older.

Nine out of 10 men aged over 50 years, and nine out of ten women aged over 60 years, have evidence of this kind of change in their necks. Neck arthritis 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.

Causes

The seven segments of bone at the top of the spinal column are known as the cervical vertebrae, and make up the part of the spinal column called the cervical spine. Between each vertebra are strong discs with a fibrous, outer layer and an inner core filled with a gel-like tissue. These discs cushion the vertebrae, protect the nerves and blood vessels between the vertebrae, and allow the spine to move.

As people 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 that can irritate nearby muscles, ligaments and nerves. When this process occurs in the cervical spine it is usually referred to as cervical spondylosis or neck arthritis. The condition may sometimes be referred cervical osteoarthritis.

This form of arthritis 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.

Signs and symptoms

Symptoms of arthritis in the neck 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. If this narrowing compresses the spinal cord it will reduce the flow of blood and nutrients to the spinal cord over time, causing damage. Symptoms of this process (called 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 affects only a small proportion of people with cervical spondylosis. 

Diagnosis

Your doctor will examine your neck and shoulder and ask about your symptoms. Based on this initial assessment they may ask you to undergo one or more of the following tests to confirm a cervical spondylosis diagnosis and pinpoint the location of the problem:

  • Neck x-rays — to show the general condition of the vertebrae.
  • Myelogram — a specialised x-ray that uses 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.
  • Electromyography (EMG)/nerve conduction tests — 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, immobilisation to limit movement of the neck may be necessary. Wearing a soft cervical collar during the daytime on a short-term basis may be recommended. Use of a moulded cervical pillow can better align the spine during sleep and may provide symptom relief. 

Cervical traction, which lightly stretches the neck may relieve compression, tension and tightness.  A physical therapist can advise on how this can be done, and whether it may be of benefit to an individual.

Physiotherapy, exercise, and lifestyle

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

The symptoms of mild cases of cervical spondylosis may be reduced by low impact aerobic exercises such as swimming or walking, and using correct posture when standing and sitting.

Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended for pain relief and to reduce inflammation. Occasionally oral corticosteroids (to reduce inflammation) or muscle relaxant medications (to treat muscle spasms) may also be prescribed. If pain is ongoing and severe, a particular antidepressant medication, amitriptyline, which is effective in treating nerve pain, may be prescribed.

For very severe pain, treatment with a corticosteroid 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.

Surgery

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 by stabilising the spine. 

References

Hassan Al-Shatoury, H.A. (2020). Cervical spondylosis (Web page). Medscape Drugs and Diseases. New York, NY: WebMD LLC. https://emedicine.medscape.com/article/306036-overview [Accessed: 28/10/20]
O’Toole, M.T. (Ed.) (2017). Cervical spondylosis. Mosby’s Dictionary of Medicine, Nursing & Health Professions (10th ed.). St Louis, MI: Elsevier.
NHS Choices (2020). Cervical spondylosis (Web Page). Redditch: National Health Service (NHS) England. https://www.nhs.uk/conditions/cervical-spondylosis/ [Accessed: 28/10/20]
O’Toole, M.T. (Ed.) (2017). Cervical spondylosis. Mosby’s Dictionary of Medicine, Nursing & Health Professions (10th ed.). St Louis, MI: Elsevier.


Last reviewed: October 2020

 
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