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Neck arthritis (cervical spondylosis)

Neck arthritis (cervical spondylosis) is a long term condition caused by degeneration of the discs and vertebrae at the top of the spinal column (the cervical spine). This degenerative, "wear and tear" process is a normal part of ageing.

Neck arthritis is a common cause of neck pain symptoms in older people. Nine out of 10 men aged over 50 years and nine out of ten women aged over 60 years have evidence of degenerative changes in the cervical spine.  

Causes

The seven vertebrae at the top of the spinal column are known as the cervical vertebrae (cervical spine). Between each 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 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.

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 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 ask you to undergo one or more of the following tests to confirm a cervical spondylosis diagnosis and pinpoint the location of the problem, particularly if surgery is contemplated:

  • Neck 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)/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, then immobilisation with a soft neck brace for a short period of time may be recommended.  Traction, which provides more space within the spine if nerve roots are being pinched, may be beneficial in some people with cervical spondylosis.

Physiotherapy, exercise and lifestyle
Physiotherapy is often recommended. This usually involves treatment with heat, postural correction and 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
  • Using a firm pillow at night to recuce strain on your neck
  • Using correct posture when standing and sitting.

Medications
Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) 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 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.

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

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 stabilising the spine. 

References

Hassan Al-Shatoury, H.A. (2017). Cervical spondylosis (Web page). Medscape Drugs and Diseases. New York, NY: WebMD LLC. https://emedicine.medscape.com/article/306036-overview#a4 [Accessed: 19/10/17]
O’Toole, M.T. (Ed.) (2013). Cervical spondylosis. Mosby’s Dictionary of Medicine, Nursing & Health Professions (9th ed.). St Louis, MI: Elsevier Mosby.
NHS Choices (2015). Cervical spondylosis (Web Page). Redditch: National Health Service (NHS) England. https://www.nhs.uk/Conditions/Cervical-spondylosis/Pages/Symptoms.aspx [Accessed: 19/10/17]
O’Toole, M.T. (Ed.) (2013). Cervical spondylosis. Mosby’s Dictionary of Medicine, Nursing & Health Professions (9th ed.). St Louis, MI: Elsevier Mosby.


Last reviewed – October 2017

 

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