The discs between the spinal bones are made of flexible but strong cartilage-like tissue filled with a gel-like material. Each disc is akin to a jelly that act like a cushion between the spinal bones. These spinal bones encase the spinal cord and nerves that carry messages between the brain and the rest of the body.
Cervical spondylosis is a broad term for age-related wear and tear affecting the spinal discs in your neck leading to neck pain and other related symptoms. This condition may also be referred to as “arthritis of the neck”.
As the disks dehydrate and shrink, signs of osteoarthritis develop, including bony projections along the edges of bones (bone spurs).
- Very common and worsens with age: > 85% older than age 60 are affected
- Mixed group of age-related degenerative disorders
- Inflammation, stiffness, and pain in your spinal joints
Progressive Disease:
Begins in middle age, the discs between the vertebrae start to change. These changes – together called cervical spondylosis, may include:
- Degenerated discs: discs may slowly get dehydrated, dry away and start to shrink (degeneration). With time, the discs become thinner, and the soft tissue has less elasticity leading to bone-on-bone contact.
- Herniated discs: Due to aging process, cracks may appear in the exterior of the disc, leading to bulging of the inner contents (herniation). This bulge may at times press on nearby spinal cord or a spinal nerve – causing pain, tingling, numbness or weakness.
- Stiffening of ligaments: cartilaginous bands connecting spinal bones get thickened and become hard, reducing flexibility
- Bone spurs: extra and abnormal bony outgrowths occur along the edges of spinal bones (osteophytes or bone spurs) as the spine tries to reduce motion. They may occasionally start compressing the spinal cord or nerves.
Risk factors and Cause:
- Age – normal part of aging – strongest risk factor
- Occupation – Professions involving continuous, repetitive neck movements, abnormal posture, or increased overhead work put excess stress on your neck.
- Injuries – Prior neck injuries increase the risk of developing cervical spondylosis.
- Genetic and hereditary factors
- Smoking – linked to accelerated degeneration
- Prior cervical spine surgery
Symptoms:
- Most of the time there may not be any symptoms
- Progressive neck pain – dull ache, soreness or spasms
- Limited range of neck movements, stiffness in the neck
- Weakness, tingling, or numbness in one or both arms or legs
- Bowel or bladder incontinence (control issues that may cause you to use the bathroom more)
- Difficulty walking (unsteady gait – loss of balance)
- Decreased functioning of hands – such as gripping objects or problems in writing or buttoning shirt etc
Diagnosis:
MRI, CT and X rays of the spine are helpful in diagnosis
Sometimes, shoulder problems maybe be confused with pain due to pressure on the nerve roots, and an orthopaedic opinion maybe obtained.
Treatment options:
- Cervical spondylosis is treated initially with a trial of conservatively management:
- Medications: for reducing pain and inflammation such as paracetamol, Non-steroidal anti-inflammatory drugs (NSAIDS) such as aspirin, ibuprofen and naproxen
- Physiotherapy: use of heat or ice packs, ultrasound, electrical stimulation, and massage along with muscle strengthening exercises. These treatments can relax tight muscles and ease pain or discomfort.
Percutaneous injection therapies –
- Local anaesthetic may be injected around the compressed nerve (transforaminal nerve sheath injection) – both diagnostic and therapeutic
- Epidural steroid injection
- Facet joint injection – Significant pain relief and psychological benefit
Surgery may be required in severe or unresponsive cases – to relieve pressure on the spinal cord and nerves, and to add stability to the spine. These include:
- Anterior cervical decompression and fusion
- Cervical arthroplasty (artificial disc insertion)
- Posterior cervical laminectomy and decompression with or without fusion
- Minimally invasive posterior cervical lamino-foraminotomy
