Definition

Cervical spondylosis is the process of age-related changes in the bones and joints of the neck, which is why it is also known as cervical osteoarthritis. Cervical spondylosis is quite common, with around 85% of people over the age of 60 having the condition. Most people do not experience any symptoms from this condition, and if they do, the symptoms can be managed without surgery.

Causes

Cervical spondylosis is affected by aging. As we age, the intervertebral discs that connect the bones become damaged. There can also be damage to the bone and joint components. This damage can include dehydration or a lack of fluid in the discs, causing them to shrink and harden from their previously soft state, which was designed to withstand the forces of pressure, rotation and other movements. As a result, the spine forms new bone to strengthen its foundation, but this can cause new bone spurs to press on the spinal cord or nerve roots. The discs can also develop cracks that allow the internal fluid to leak out, known as a herniation. This leakage of fluid can press on the spinal cord and nerve roots.

In some cases, damage to these structures causes pressure on the spinal cord, the blood vessels that supply the spine, and the nerve roots. As a result, symptoms can include neck pain, damage to the spinal cord in the neck and damage to the nerve roots in the neck.

Risk factor

The risk factors for cervical spondylosis are closely linked to age. In people over 50, the discs between the vertebrae harden. Age also causes the bones and ligaments (the connections between the bones) to thicken and harden, sometimes encroaching on the space for the spinal cord in the spinal canal.

However, several factors can accelerate the development of cervical spondylosis. These risk factors include previous spinal trauma, a narrow spinal canal, and sports that involve a lot of spinal movement, such as gymnastics, football, horseback riding, and so on.

Symptoms

Generally, cervical spondylosis does not cause any symptoms. If symptoms do occur, common complaints include neck pain and stiffness. If there is pressure on the spinal cord or nerve roots, symptoms may include tingling, numbness and muscle weakness in the arms, hands, legs or feet. Other symptoms may include difficulty coordinating body movements, difficulty walking, and problems controlling bowel or bladder function.

Diagnosis

Diagnosis of cervical spondylosis may begin with questions about medical history, activities, and any spinal trauma. A physical examination of the neck, shoulders and arms is then carried out. To check nerve function, you may be asked to feel sensations such as touch, temperature and body position, and to move your limbs. Reflexes in certain muscles will also be observed to assess spinal cord function.

Various imaging tests may be done to look at the shape of the spine. For example, X-rays may be used if you have neck pain without neurological symptoms. X-rays of the neck can show narrowing of the vertebral spaces or new bone growth. Computed tomography (CT) scans are more sensitive than X-rays and can show abnormalities in the bones more clearly. This test can be enhanced with a contrast agent injected into the fluid near the spinal cord (intrathecal) to see nerve compression in more detail. Meanwhile, magnetic resonance imaging (MRI) is useful for looking at soft tissue, spinal cord and nerve involvement in this condition.

If this condition is suspected of causing nerve root compression, an electromyography test may be carried out. This test looks at the electrical conduction in the nerves and muscles.

Management

Treatment for cervical spondylosis depends very much on the signs and symptoms experienced by the patient. If the symptoms are limited to neck pain without neurological symptoms, therapy will focus on relieving pain, improving the ability to perform daily activities, and preventing permanent injury. 

Treatment begins with 4-6 weeks of physiotherapy, including exercises to strengthen the neck and upper back muscles. Medication is usually used to relieve pain. In addition, the use of devices such as a soft cervical collar can reduce neck pain and muscle stiffness. This device can also be used during sleep to improve posture and distribute the mechanical load on the intervertebral discs.

If your condition is mild, you can do the following at home

• Take painkillers such as paracetamol, ibuprofen or naproxen. Read the instructions before taking them and see a doctor if you have side effects such as stomach pain or black stools.
• Apply heat or cold to your neck to relieve pain caused by stiff muscles.
• Exercise regularly to help your recovery. Recommended exercises include swimming, aerobic exercise and other activities that strengthen the neck and upper back muscles. However, avoid sports that involve sudden movements and pressure, such as running, jumping and weightlifting.
• Use a soft neck support to relieve symptoms. However, do not use a neck support for too long as it can weaken the neck and upper back muscles.

If this therapy does not work, or if there are neurological symptoms such as numbness, muscle weakness or tingling, surgery may be an option. Surgery aims to relieve pressure on the spinal cord and nerves.

Complications

Cervical spondylosis is a common and manageable condition, but it can cause complications in more severe cases. If the pressure on the spinal cord or nerve roots is too severe, permanent damage can occur.

Additionally, complications can arise from surgery, such as injury to the spinal cord and nerve roots, infection near the surgical wound, leakage of fluid near the spinal cord (cerebrospinal fluid), injury to nerves near the neck, difficulty swallowing, injury to blood vessels in the neck, injury to the respiratory tract, damage to structures near the surgical site, and so on.

Prevention

Cervical spondylosis may not be preventable due to its association with aging, but its risk can be reduced by regular physical activity, maintaining good posture, preventing neck injuries by using appropriate equipment and maintaining proper posture during sports, and avoiding impacts to the neck.

When to see a doctor?

See a doctor immediately if you or someone close to you suddenly experiences muscle weakness, skin numbness, or loss of bowel or bladder control, especially if accompanied by a history of recurrent neck pain. These symptoms are warning signs of cervical spondylosis, as they indicate pressure on the spinal cord or nerve roots. If not treated promptly, this condition can cause permanent damage to the spinal cord and nerve roots.

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