Makindo Medical Notes.com

Cervical spondylosis is a degenerative condition that affects the cervical spine (the neck). It is caused by wear and tear of the vertebrae and the intervertebral discs, leading to changes in the bones, discs, and joints of the neck. This condition is very common, particularly in older adults, and is a natural part of aging.

About

• A cause of neck pain and arm weakness
• Affect the lower cervical roots
• Most disease happens at C5-6, C6-7, C3-4

Aetiology

• Simple ageing can lead to changes that impinge on the cord.
• Spondylosis is the natural wearing down of these parts of the spine.
• Disc degeneration, osteophyte formation, hypertrophy of articular facets
• A thickened ligamentum flavum all give rise to a narrowed spinal canal.
• Central protrusions give cord compression type symptoms
• Posterolateral compression on roots gives pain, paraesthesia, weakness, wasting and reduced reflexes

Risks

• Smoker
• Family history
• Neck strain e.g. painters or plumbers or flooring installers) or staring at a computer screen that is too high or low).
• Previous neck injury
• Heavy lifting like construction workers.
• Exposed to a lot of vibrations like bus or truck drivers.

Cervical Spondylotic Myelopathy occurs if cervical canal diameter falls from 17 mm to below 13 mm as the cord itself, is 8-11.5 mm in diameter.

Clinical

• Neck Pain: Chronic pain in the neck, which may radiate to the shoulders and arms.
• Stiffness: Reduced range of motion in the neck, particularly after periods of inactivity.
• Headaches: Often originating from the neck (cervicogenic headaches).
• Radiculopathy: Nerve root compression may lead to pain, numbness, tingling, or weakness in the arms or hands.
• Myelopathy: Severe cases may involve spinal cord compression, leading to weakness, coordination problems, and difficulty walking.
• Cervical Crepitus: A grinding noise or sensation when moving the neck.

Investigations

• MRI - cord can become indented, flattened and distorted. There may well be changes such as gliosis and ischaemia and demyelination. Cord atrophy and static T2 hyperintensities suggesting gliosis rather than oedema do not bode well.
• Nerve conduction studies and electromyogram may be useful

Differentials

• MND, MS, B12 deficiency
• HTLV1 myelopathy
• Adrenoleukodystrophy
• Syringomyelia and tumour

Management

Management of cervical spondylosis depends on the severity of symptoms and the degree of spinal involvement:

• Conservative Treatment:
  • Physical Therapy: to strengthen the neck muscles, improve flexibility, and relieve pain.
  • Medications: NSAIDs, muscle relaxants, and analgesics for pain relief.
  • Neck Brace: for short-term use to support the neck and reduce pain.
  • Hot or Cold Therapy: heat or cold to reduce pain and inflammation.
  • Postural Training: education on proper posture to reduce strain on the neck.
• Interventional Treatments:
  • Epidural Steroid Injections: reduce inflammation and relieve pain, particularly in cases of radiculopathy.
  • Facet Joint Injections: pain relief from arthritis in the facet joints.
• Surgical Treatment:
  • Anterior Cervical Discectomy and Fusion (ACDF): Removal of a herniated or degenerated disc and fusion of the adjacent vertebrae.
  • Laminectomy: Removal of part of the vertebra (the lamina) to relieve pressure on the spinal cord or nerves.
  • Foraminotomy: Enlargement of the foramen (the opening where the nerve roots exit the spine) to relieve nerve compression.
  • Artificial Disc Replacement: Replacing a damaged disc with an artificial one, allowing for greater range of motion compared to fusion.

Prognosis

Cervical spondylosis is a chronic condition that typically progresses over time. While it cannot be cured, symptoms can often be managed effectively with conservative treatment. Severe cases involving significant neurological impairment may require surgical intervention. Early diagnosis and appropriate management can help improve quality of life and prevent complications.