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Cervical spondylosis

Cervical spondylosis is a disorder in which there is abnormal wear on the cartilage and bones of the neck (cervical vertebrae), including the disks or cushions between the neck vertebrae and the joints between the bones of the cervical spine. There may be abnormal growths or "spurs" on the vertebrae of the spine.

These changes can, over time, compress one or more of the nerve roots. In advanced cases, the spinal cord becomes involved. This can affect not just the arms, but the legs as well.

Everyday wear and tear may start these changes. People who are very active at work or in sports may be more likely to have them, but the major risk factor is aging. By age 60, most women and men show signs of cervical spondylosis on x-ray. Other factors that can make a person more likely to develop spondylosis are:

  • Being overweight and not exercising
  • Having a job that requires heavy lifting or a lot of bending and twisting
  • Past neck injury
  • Past spine injury
  • Herniated disc
  • Severe arthritis
  • Vertebral compression fractures from osteoporosis


Common Symptoms

Symptoms often develop slowly over time, but they may start or worsen suddenly. They include:

  • Neck pain
  • Neck stiffness that worsens over time
  • Numbness or abnormal sensations in the shoulders, arms or more rarely, in the legs
  • Headaches, especially in the back of the head
  • Loss of balance
  • Loss of control over the bladder or bowels if there is pressure on the spinal cord

Pain caused by cervical spondylosis may be mild, or it can be deep and so severe that you are unable to move. You may feel the pain over the shoulder blade, or it may spread to the upper arm, forearm or fingers.

The pain may get worse at night; after standing or sitting; when you sneeze, cough or laugh; or when you bend the neck backwards or walk more than a few yards.

You may also have weakness in certain muscles and will notice that you have a hard time lifting your arm, squeezing tightly with one of your hands or other problems.

Diagnosis

A physical exam may show that you have trouble moving your head toward your shoulder and rotating your head. Your doctor may ask you to bend your head forward and to the sides while putting slight downward pressure on the top of your head. Increased pain or numbness during this test is usually a sign that there is pressure on a nerve in your spine. Weakness or loss of feeling can be signs of damage to certain nerve roots or to the spinal cord. Reflexes are often reduced.

A spine or neck x-ray may be done to look for arthritis or other changes in your spine.

MRI of the neck is done when you have:

  • Severe neck or arm pain that does not get better with treatment
  • Weakness or numbness in your arms and hands


Electromyography (EMG) and nerve conduction velocity testing may be done to examine nerve root function.

Treatment

Your doctor and other health professionals can help you manage your pain and keep you as active as possible. You may be referred to a physical therapist, who will use stretches and exercises to strengthen your neck muscles and help you reduce your pain. Learning to take care of your neck and back at home can prevent repeat episodes of pain and help you avoid surgery.

Cold packs and heat therapy may help your pain during flare-ups. A type of talk therapy called cognitive behavioral therapy may be helpful if the pain is having a serious impact on your life. This technique helps you better understand your pain and teaches you how to manage it.

A number of different medications can help with your neck pain:

  • Nonsteroidal anti-inflammatory drugs, such as naproxen sodium (Aleve) and ibuprofen (Advil) may help with the pain.
  • Low doses of prescription medicines used to treat seizures (called anticonvulsants) or antidepressants may help some people whose long-term neck pain has made it difficult for them to work or interferes with daily activities


We offer osteopathic manipulation therapy through our Physical Medicine and Rehabilitation Program, or you may be referred to a pain medicine specialist at the Neuroscience Institute.

If the pain does not respond to these treatments, or you have a loss of movement or feeling, your doctor may recommend surgery to relieve pressure on the nerves or spinal cord.

Foraminotomy may be performed on any level of the spine. The procedure takes pressure off a nerve in your spinal column and allows it to move more freely without pain.

Laminectomy is surgery to remove the lamina, part of the bone that makes up a vertebra, or bone spurs in your spine. The procedure can take pressure off your spinal nerves or spinal canal.

Spinal fusion permanently joins two bones together so that there is no longer movement between them. Spinal fusion is usually done along with other surgical procedures of the spine.

Most patients with cervical spondylosis will have some long-term symptoms. These symptoms will often get worse and then improve. However, symptoms should improve with treatment. Many people with this condition are able to maintain active lives.

Source: National Institutes of Health

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