Cervical Spondylosis
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Cervical spondylosis is the natural wearing down of cartilage, disks, ligaments and bones in your neck. Main symptoms include neck pain or stiffness. Physical therapy; ice, heat, massage; soft collar and drugs are first-to-be-tried approaches. More severe cases, such as herniated disk, bone spurs or pinched nerves, are treated with injections or surgery.
What is cervical spondylosis?
Cervical spondylosis is a general term for age-related wear and tear in the cervical spine (neck) that can lead to neck pain, neck stiffness and other symptoms. Sometimes this condition is called arthritis or osteoarthritis of the neck.
What are the parts of the cervical spine?
Your entire spine is made up of 24 vertebrae (bones of the spine). The cervical spine consists of seven vertebrae that begin at the base of the skull. Running through an opening of the entire vertebral column are the spinal cord and its nerves. The spinal cord and nerves carry messages between the brain and rest of body, including muscles and organs. Between each vertebrae are disks. The disks act like the body’s shock absorbers. The disks are made of flexible but strong connective tissue filled with a gel-like material. Disks are like “jelly-filled, cushy doughnuts” between each vertebrae.
There are three joints between each pair of vertebrae. The front joint is called the intervertebral disk. Two joints in the back of the spine are called facet joints. Within every joint is cartilage, which cushions the ends of bones. Ligaments are soft bands of tissue that connect the vertebrae together.
Spondylosis is the natural wearing down of these parts of the spine. Cartilage wears out over time, disks lose their volume and become dried and cracked, ligaments may thicken and bone spurs may form where bones rub against each other in areas that are no longer covered with cartilage. All of these changes are defined as spondylosis.
SYMPTOMS AND CAUSES
As you get older, your spine undergoes changes due to decades of normal wear and tear. Starting in middle age, the disks between your vertebrae start to change. These changes can include:
- Degeneration: The spinal disks in your neck may slowly wear down (degenerate). With time, the disks become thinner, and the soft tissue has less elasticity. If you or your parents measure in a little shorter in height than you did years ago, this is normal collapsing or settling of your disks.
- Herniation: Normal aging can cause part of your spinal disk to tear or crack. This is called a herniated disk. The herniation can allow the disk to bulge out, pressing on nearby tissue or a spinal nerve. This pressure can cause pain, tingling or numbness.
- Osteoarthritis: Osteoarthritis is a progressive (ongoing) condition that causes cartilage in your joints to degenerate (wear down with time). With osteoarthritis, cartilage degenerates faster than with normal aging.
- Bone spurs: When cartilage in the joints of the vertebrae in your spine starts to degenerate and bone tissue rubs directly against other bone tissue, abnormal bone growths develop along the edges of vertebrae. These growths (called osteophytes or bone spurs) are common as you age. Often, they cause no symptoms.
You may have cervical spondylosis and not even know it. It’s common to have no symptoms related to this condition.
If you do experience symptoms, symptoms typically include:
- Neck pain or stiffness. This may be the main symptom. Pain may get worse when you move your neck.
- A nagging soreness in the neck.
- Muscle spasms.
- A clicking, popping or grinding sound when you move your neck.
- Dizziness.
- Headaches.
MANAGEMENT AND TREATMENT
What are common cervical spondylosis treatments?
Cervical spondylosis does not always cause symptoms. Without symptoms, you may not need treatment at all.
When your condition does cause symptoms, conservative treatments effectively treat most cases. Your healthcare provider may recommend:
- Physical therapy: Your symptoms may be relieved with specific exercises and stretches. Physical therapy focuses on stretching and strengthening your muscles and improving your posture. You may do these stretches at home or need the assistance of a physical therapist at a clinic. Your healthcare provider will advise how long and how often you should practice these exercises, based on your individual symptoms and condition.
- Ice, heat and massage can help relieve your symptoms. You’ll have to conduct your own trial to see if heat or cold best relieve your pain and discomfort. Apply heat or ice typically no more than 20 minutes at a time, several times a day. Massage is another option that may be tried in some patients. Ask your healthcare provide if this is a reasonable option for what’s causing your specific problem.
- Oral medications: Depending on how much pain you’re in, a healthcare provider might recommend prescription or over-the-counter anti-inflammatory drugs like ibuprofen or naproxen sodium . Muscle relaxants such as cyclobenzaprine (Amrix®, Fexmid®) can treat muscle spasms. For severe arm pain from nerve impingement, gabapentin may reduce the pain.
- Soft collar or brace: Your healthcare provider may recommend you wear a therapeutic collar for a short time. This can limit neck movement and help strained muscles rest and recuperate. Wearing a brace for too long can lead to muscle atrophy (wasting away). Only use a collar under the guidance of a medical professional.
- Injection therapy: Steroids can be injected into the affected area of the spine. Injection medications can make your symptoms better for a short period of time. There are three common steroid injection procedures:
- Cervical epidural block: Neck or arm pain due to cervical disk herniation can be treated with an injection of a combination of a steroid and anesthetic. The injection is made into the epidural space, which is the space next to the covering of the spinal cord.
- Cervical facet joint block: This steroid plus anesthetic injection is made into small joints at the affected segments of the cervical spine.
- Media branch block and radiofrequency ablation: This technique is used to both diagnosis and treat chronic neck pain. If pain is relieved with an injection of an anesthetic, that spot is identified for treatment. The treatment, called radiofrequency ablation, involves damaging the nerves with sound waves that are causing pain in the joint.
For the most severe cases of cervical spondylosis – including cervical myelopathy or cervical radiculopathy – your healthcare providers may consider surgery. Surgeries can involve removing bone spurs and fusing together the vertebrae or creating more room for the spinal cord by removing a portion of vertebrae.
Spine surgery is complex and may involve a lengthy recovery. Your healthcare provider will consider your symptoms, condition and overall health before deciding whether surgery may benefit you.
Cervical spondylosis is a degeneration – or breakdown – of the spine and disks in your neck. It is a general term for the situation that occurs in your neck area. It is an arthritis of the joints (the spaces) between the vertebrae in the neck.
Spondylitis is inflammation of one or more vertebrae. “Itis” means inflammation. Ankylosing spondylitis is a type of arthritis in your spine. Ankylosing spondylitis can result in vertebrae fusing together.
Spondylolysis is a physical break in the mid-arch area of a section of vertebrae called the pars interarticularis. The pars interarticularis are the horizontal pieces on the sides of the main body of each vertebrae – the “wings” on the body of each vertebrae. This condition is usually caused by injury, trauma or overuse by hyperextension (for example, weight lifters, tennis players). Spondylolysis usually occurs in the lumber (lower back) spine.
Cervical spondylolisthesis is a specific condition in which one vertebra slips forward over the vertebrae beneath it. A fracture (break) or injury of the vertebrae of the spine can cause the vertebra to start to shift out of place.
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