Introduction:

Cervical spondylosis is a condition that causes degeneration of vertebrae, discs, and ligaments in the neck of cervical spine. The cervical spine refers to seven small vertebrae that form the neck. They start at the base of skull.

      In cervical spondylosis, the edges of vertebrae often develop spurs called osteophytes and there is involvement of adjacent soft tissue structures. Over time, the disc gets thinner and their ability to absorb shock is lost, increasing the risk of symptoms.

     Swollen neck joints, called facet joints, can press or pinch nearby nerve roots or the spinal cord itself, resulting in tingling in extremities and sometimes even pain in limbs.

     Nearly 85% of the people over the age of 60 years live with cervical spondylosis, but not all of them experience pain.

Causes:

Cervical spondylosis occurs because of long term degeneration and wear-and-tear of cervical spine. A previous neck injury may also lead to condition. Possible causes of the condition are:

·       Bone spurs: These overgrowths of bone are the result of body trying to grow extra bone to grow spine stronger.  However, the extra bone can press on the delicate areas of spine, such as spinal cord and nerves, resulting in pain.

·       Dehydrated spinal discs: Spinal bones have discs between them, which are cushion that absorb the shock of lifting, twisting and other activities. The gel-like material in between these discs can dry out over time. This causes bones (spinal vertebrae) to rub together more which can be painful. This process can begin to happen in 3rd decade of life.

·       Herniated discs: Spinal discs can develop cracks which allow the leakage of internal cushioning material. This material can press in the spinal cord and nerves resulting in arm numbness as well as pain that radiates down an arm.

·       Ligament stiffness: The tough cords that connect the spinal bones to each other can become stiffer over time, which affects neck movement and makes the neck feel tight.

·       Injury:  Injury to neck during a call or car accident for example can accelerate the aging process.

·       Overuse: Some occupations or hobbies involve repetitive movements or heavy lifting which can put extra pressure to spine, resulting in early wear-and-tear.

 Symptoms:

Most people with cervical spondylosis don’t have significant symptoms. If present, symptoms can vary from mild to severe, and may develop gradually or suddenly.

Some common symptoms are:

·       Pain around shoulder blade or along the arm and in fingers. Pain may increase when Standing, Sitting, Sneezing, Coughing, Tilting

·       Muscle weakness, makes it hard to lift the arms and hold objects firmly.

·       Headache that mostly occurs in the back of head.

·       Tingling and numbness mainly in shoulders and arms, can affect legs as well.

·       Loss of balance and a loss of bladder or bowel are less frequent symptoms which need immediate medical attention.

Diagnosis:

Making a diagnosis of cervical spondylosis involves ruling out of other potential conditions like fibromyalgia. Also involves testing for movement and determining the affected nerve, muscle and bone.

·       Physical examination: It includes testing of reflexes, checking for muscle weakness or sensory deficit, and testing the range of motion of neck.

 ·       Imaging tests

  • X- rays can be used to check for bone spurs and other abnormalities.
  • A CT scan can provide more detailed images of neck.
  • An MRI scan helps to locate pinched nerves.
  • In a myelogram, dye is used which along with CT gives a more detailed image.
  • An electromyogram EMG) is used to check that the nerves are functioning normally when sending signal to muscles.

 Treatment:

Treatment of cervical spondylosis focuses on relieving pain and lowering the risk of permanent damage. Non-surgical methods are very effective.

Medications:

  • Muscle relaxants such as cyclobenzaprine to treat muscle spasms.
  • Narcotics such as hydrocodone for pain relief.
  • Anti- epileptic drug such as gabapentin to relieve pain caused by nerve damage
  • Steroid injection like Prednisone to reduce the tissue inflammation and relieve pain.
  • Non steroid anti-inflammatory drugs (NSAIDs) like diclofenac to relieve pain.

Physical Therapy  Treatment

Treatment should be individualized but generally includes rehabilitation exercises, proprioceptive re-education, manual therapy and postural education.

  • Manual therapy: Manual therapy of thoracic spine can be used for reduction of pain, improving function, to increase the range of motion, and to address the thoracic hypomobility.
  • Thrust manipulation: includes technique in a prone supine or sitting position based on therapist’s preference. Also, cervical traction can be used to enlarge the neural foramen and reduce neck stress.
  • Non thrust manipulation: includes posterior anterior (PA) glide planes in prone position. The cervical spine techniques could include retraction, rotation, glides in ULTT1(Upper Limb Tension Test 1) position and PA glides. The technique is choose based on patient’s response.
  • Postural education: includes the alignment of supine during sitting and standing activities.
  • Soft tissue mobilization: is performed on the muscles of upper quarter with the involvement of upper extremity positioned in abduction.
  • Thermal therapy: provides symptomatic relief only.
  • Cervical traction: is incorporated in patients experiencing radicular pain. It is done to alleviate the nerve roots compression that occurs with foraminal stenosis.

 

Home Treatment/Tips:

  • Use a healing pad or cold pack on your neck to provide relief for sore muscles.
  • Exercise regularly to help you recover faster.
  • Wear a soft neck brace or neck collar to get temporary relief. However, wearing neck brace or collar for long time can make your muscles weaker.

 

References:

Ferrara LA. The biomechanics of cervical spondylosis. Advances in orthopedics 2012. Feb1, 2012.

McCormack BM, Weinstein PR. Cervical spondylosis. An update. West J Med. Jul- Aug 1996.

Kisner, Colby., 2007, Apr. Therapeutic exercise