Cervical Spondylosis

Professor Nicola Portinaro explains symptoms, causes, diagnosis and treatment of Cervical Spondylosis.

What is cervical spondylosis?

Cervical spondylosis is a condition that affects vertebrae, discs, and ligaments of the neck. It is an age-related disease also known as cervical osteoarthritis or neck arthritis.

Starting at the base of the skull, there are seven vertebrae form the cervical spine in your neck. The wear and tear of cartilage and bones affect the cervical spine and in particular the spinal discs in the neck.

Those discs get thinner over time and they lose the capacity to absorb shocks.

It is a very common condition that worsens with age (around 85/90 per cent of people aged 60 and older)

Cervical spondylosis symptoms

Most people affected by cervical spondylosis experience no significant symptoms.
When they occur they may include pain and stiffness in the neck, headache, occasionally. Symptoms can vary from mild to severe.

Sometimes neck pain can spread to the shoulders, arms and hands.

Neck stiffness is more common after sleeping or a period of inactivity.

Headaches usually involve the back of the head and move towards the front.

It the cervical spondylosis causes a reduction of the space in the spinal cord, the nerve roots that pass through the spine may be compressed. In such a situation symptoms may include:

• Weakness, insensibility, pins and needle feeling in your upper and lower limbs
• Lack of coordination
• Limbs pain

If there is also a compression of the blood vessels, this can affect the blood supply to the brain causing vertigo and even blackouts.

Cervical spondylosis causes

Cervical spondylosis occurs as you age because the cartilage in the cervical spine degenerates and develop wear and tear.

Possible causes include:

• Dehydrated spinal discs. Inside the spinal discs, there is a gel-like material that can dry over time. This increases the contact between the bones of the vertebrae and causes pain
• Bone spurs. the body can try to grow an extra amount of bones to make the spine stronger. these bone spurs can pinch the nerve root and the spinal cord
• Herniated discs. Spinal discs can develop cracks that lead to herniated discs. The material that leaks out can press the spinal cord and nerves and cause Cervical spondylosis symptoms
• Stiff ligaments. Ligaments are tough cords that connect your spinal bones to each other. They can become stiffer over time, affecting neck movement and making the neck tight and less flexible.
• Injury and Overuse. If you’ve had a car accident that injured your neck this can accelerate the ageing process. Also overuse due to a particular occupation or repetitive activity that involve the movement of your neck or heavy lifting can result in premature wear and tear.

Risk Factors

The main risk factors of cervical spondylosis are:

• Age
• Neck Injuries
• Work-related activities that involve carrying heavy loads, being a professional gymnast or dancer, practising martial arts
• Genetic factors (family history)
• Smoking
• Being overweight
• Body malposture

Cervical Spondylosis Diagnosis

We suggest you see a doctor if pain interferes with your daily routine and, in particular, if you experience a sudden onset of symptoms such as weakness, insensibility, pins and needle feeling in your upper and lower limb, lack of coordination and incontinence.

The doctor will perform a physical examination with the aim of:

• Checking the range of motion in your neck
• Testing your muscle strength
• Testing your skin sensation
• Testing your reflexes

The doctor may also recommend some diagnostic test such as

• X-rays to look for bone spurs or other abnormalities (tumours, infections, fractures)
• CT Scan for more detailed imaging of your bones
• MRI to have a closer look at your nerves
• Electromyography to test the electrical activity in your nerves and their functionality

Treatment for cervical spondylosis

If symptoms don’t resolve over time without treatment, your doctor may suggest some of the following methods.

Nonsurgical methods are the first option

Medications such as:

• Muscle relaxants such as cyclobenzaprine to reduce spasm in the neck
• Nonsteroidal anti-inflammatory drugs
• Corticosteroids and steroid injections (if the pain is severe)
• Physical therapy to stretch your neck and shoulders muscles.
• Neck Traction – to relieve the pressure on the cervical discs and nerve roots
• Other drugs such as epilepsy medications and antidepressant have been found to help relieve neck pain caused by nerve damage

Home remedies and Lifestyle

If you are affected by a mild cervical spondylosis you can try some home remedies such as:

• Exercise. Walking daily may reduce your neck pain and low back pain as well
• Over-the-counter pain relievers such as Ibuprofen and others NSAID (nonsteroidal anti-inflammatory drugs)
• Apply heat or ice to release tension in neck muscles and reduce pain
• Soft neck brace can allows your neck muscles to rest (this solution may weaken muscles so it not a long-term remedy)

Surgery
If symptoms get worse and don’t resolve with nonsurgical treatment surgery may be an option. Even if surgery is quite rare for this condition, it may be an option if your symptoms include weakness in arms or legs due to nerve problems. If imaging tests such as MRI indicate that you have a nerve root compression and pressure on the spinal cord, surgery can help relieve symptoms.

The orthopedic surgeon may perform the following surgeries techniques in order to:

• Remove a herniated disk or bone spurs or portion of a disk in order to take the pressure off the spinal nerve root
• Remove part of a vertebrae
• Perform Cervical fusion, with bone graft in order to reduce pressure on the spinal cord.

The experience of Prof. Portinaro

Although Prof Portinaro is mainly a Pediatric Orthopedic Surgeon, he has been treating spinal diseases, including scoliosis and low back pain, for more than 30 years both in young and adult patients. He always gives priority to non-surgical treatment.