Cervical spondylosis

Skeletal spine — The spine is divided into several sections. The cervical vertebrae make up the neck. The thoracic vertebrae comprise the chest section and have ribs attached. The lumbar vertebrae are the remaining vertebrae below the last thoracic bone and the top of the sacrum. The sacral vertebrae are caged within the bones of the pelvis, and the coccyx represents the terminal vertebrae or vestigial tail.

Also known as: Cervical osteoarthritis, Arthritis - neck or Neck arthritis

Definition

Cervical spondylosis is a disorder in which there is abnormal wear on the cartilage and bones of the neck (cervical vertebrae).

Causes, incidence, and risk factors

Cervical spondylosis is caused by chronic wearing away (degeneration) of the cervical spine, including the cushions between the neck vertebrae (cervical disks) and the joints between the bones of the cervical spine. There may be abnormal growths or "spurs" on the bones of the spine (vertebrae).

These changes can, over time, press down on (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.

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:

Past neck injury (often several years before)
Severe arthritis
Past spine surgery

Symptoms

Symptoms often develop slowly over time, but may start suddenly.

More common symptoms are:

Neck pain (may radiate to the arms or shoulder)
Neck stiffness that gets worse over time
Loss of sensation or abnormal sensations in the shoulders, arms, or (rarely) legs
Weakness of the arms or (rarely) legs
Headaches, particularly in the back of the head

Less common symptoms are:

Loss of balance
Loss of control over the bladder or bowels (if spinal cord is compressed)

Signs and tests

Examination often shows limited ability to bend the head toward the shoulder and rotate the head.

Weakness or loss of sensation can be signs of damage to specific nerve roots or to the spinal cord. Reflexes are often reduced.

The following tests may be done:

CT scan or spine MRI
Spine or neck x-ray
EMG
X-ray or CT scan after dye is injected into the spinal column (myelogram)

Treatment

Even if your neck pain does not go away completely, or it gets more painful at times, learning to take care of your back at home and prevent repeat episodes of your back pain can help you avoid surgery.

Symptoms from cervical spondylosis usually stabilize or get better with simple, conservative therapy, including:

Nonsteroidal anti-inflammatory medications (NSAIDs)
Narcotic medicine or muscle relaxants
Physical therapy to learn exercises to do at home
Cortisone injections to specific areas of the spine
Various other medications to help with chronic pain, including phenytoin, carbamazepine, or tricyclic antidepressants such as amitriptyline

If the pain does not respond to these measures, or there is a loss of movement or feeling, surgery is considered. Surgery is done to relieve the pressure on the nerves or the spinal cord.

Expectations (prognosis)

Most patients with cervical spondylosis will have some long-term symptoms. However, they respond to nonsurgical treatments and do not need surgery.

Complications

Chronic neck pain
Inability to hold in feces (fecal incontinence) or urine (urinary incontinence)
Progressive loss of muscle function or feeling
Permanent disability (occasional)

Calling your health care provider

Try home treatments, such as the use of a cervical collar (which you can buy at pharmacies) and over-the-counter pain medications.

Call your health care provider if:

The condition becomes worse
There are signs of complications
You develop new symptoms (such as loss of movement or sensation in an area of the body).

Prevention

Many cases are not preventable. Preventing neck injury (such as by using proper equipment and techniques when playing sports) may reduce your risk.

References

Feske SK, Cochrane TL. Degenerative and compressive structural disorders. In: Goetz CG. Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 29.

Polston DW. Cervical radiculopathy. Neurol Clin. 2007;25:373-385.

Devereaux M. Neck pain. Med Clin North Am. 2009;93:273-284.

Review date:: July 10, 2009
Reviewed by:: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; and C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Dept. of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.