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Cervical Spondylosis

cervical spondylosis

Cervical spondylosis is a 'wear and tear' of the vertebrae and discs in the neck.To an extent, we all develop some degeneration in the vertebrae and discs as we become older. It tends to start sometime after the age of about 30. One feature of the degeneration is that the edges of the vertebrae often develop small, rough areas of bone called osteophytes.

Also, over many years, the discs become thinner. This degeneration is a normal ageing processIt is a normal part of ageing and does not cause symptoms in many people. However, it is sometimes a cause of neck pain. Symptoms tend to come and go.

What are the symptoms of cervical spondylosis?

If symptoms develop, they can range from mild to severe. Symptoms may include:

Pain in the neck. This may spread to the shoulders and base of the skull. Movement of the neck may make the pain worse. The pain sometimes spreads down an arm to a hand or fingers. This is caused by irritation of a nerve which goes to the arm from the spinal cord in the neck. The pain tends to come and go with flare-ups from time to time. You may have a flare-up of pain after unaccustomed use of your neck, or if you sprain a neck muscle or ligament. However, a flare-up often develops for no apparent reason. Some people develop chronic (persistent) pain.

Some neck stiffness, particularly after a night's rest.

Headaches may occur. The headaches often start at the back of the head just above the neck and travel over the top to the forehead.

You may develop 'pins and needles' in part of an arm or hand. This symptom is caused by irritation of a spinal nerve as it leaves the vertebral area. However, do tell a doctor if loss of feeling (numbness) or weakness develops in a part of a hand or arm. These symptoms suggest more pressure on a nerve. This is called a 'cervical radiculopathy'.

More rarely, clumsiness of a hand, problems with walking, or problems with bladder function occur when pressure from a worn vertebra or disc damages the spinal cord. This is called 'cervical myelopathy'. Again, it is important to report these symptoms to a doctor.

Cervical radiculopathy and cervical myelopathy are discussed further later in the leaflet. The following section concerns cervical spondylosis without radiculopathy or myelopathy.

What are the treatments for cervical spondylosis without radiculopathy or myelopathy?

Exercise your neck and keep active

Aim to keep your neck moving as normally as possible. During flare-ups the pain may be quite bad, and you may need to rest for a day or so. However, gently exercise the neck as soon as you are able. You should not let it 'stiffen up'. Gradually try to increase the range of the neck movements. Every few hours gently move the neck in each direction. Do this several times a day.

As far as possible, continue with normal activities. You will not cause damage to your neck by moving it.

Medicines

Painkillers are often helpful.

Paracetamol or other anti -inflammatory painkillers. Some people with stomach ulcers, asthma, high blood pressure, kidney failure, or heart failure may not be able to take anti-inflammatory painkillers.

A stronger painkiller such as codeine is an option if anti-inflammatories do not suit or do not work well. Codeine is often taken in addition to paracetamol. Constipation is a common side-effect from codeine. To prevent constipation, have lots to drink and eat foods with plenty of fibre.

A low dose tricyclic antidepressant, such as amitriptyline, is sometimes used for chronic (persistent) neck pain.

Other treatments

Some other treatments which may be advised include:

A good posture may help. Check that your sitting position at work or at the computer is not poor (that is, not with your head flexed forward with a stooped back). Sit upright.
A firm supporting pillow seems to help some people when sleeping. Try not to use more than one pillow.

Physiotherapy. Various treatments may be advised by a physiotherapist. These include traction, heat, cold, manipulation, neck exercises etc. The value of each of these treatments is uncertain. A common situation is for a doctor to advise on painkillers and gentle neck exercises.

Treatment may vary and you should go back to see a doctor:

If the pain becomes worse or severe.

If other symptoms develop such as loss of feeling (numbness), weakness, or persistent pins and needles in a part of an arm or hand, as described previously.

If you develop any problems with walking or with passing urine. Again these symptoms suggest that cervical myelopathy may be developing as a complication of the cervical spondylosis.

If you develop dizziness or blackouts when turning the head or bending the neck.

Cervical radiculopathy and cervical myelopathy

Cervical spondylosis can progress to cause cervical radiculopathy or cervical myelopathy (described below). Most cases do not. However, it may be useful to be aware of the symptoms that suggest they may be happening, particularly as some of them may develop slowly. See a doctor if you suspect that you are developing cervical radiculopathy or cervical myelopathy.

Cervical radiculopathy

This occurs when the root of a nerve is pressed on or damaged as it comes out from the spinal cord in the neck (cervical) region. Although there are other causes of radiculopathy, cervical spondylosis is a common cause. As well as neck pain, symptoms of radiculopathy include loss of feeling (numbness), pins and needles, pain and weakness in parts of an arm or hand supplied by the nerve. These other symptoms may actually be the main symptoms rather than neck pain. The pain may be severe enough to interfere with sleep. If the upper vertebrae are involved, the pain and numbness occur at the back and the side of the head.

MRI scan which will show whether the nerve roots are being pressed on.

Treatment will depend on how severe the pressure and damage is. In many cases the symptoms settle over time. A course of physiotherapy or a neck collar used for a prescribed period may help. However, in some situations, surgery may be recommended which aims to relieve the pressure on the nerve. Depending on the cause, this may involve surgery to the disc or to the vertebra itself.

Cervical myelopathy

This occurs when there is pressure on or damage to the spinal cord itself. Again, cervical spondylosis is a common cause of this condition as the degenerative changes to the vertebra can narrow the canal through which the spinal cord passes. A prolapse of a cervical disc can also cause myelopathy if the prolapse is into the central canal of the vertebra. This may happen suddenly or develop over a period of time.

The symptoms of a cervical myelopathy may include:

Difficulties with walking. For example, the legs may feel stiff and clumsy.

Changes to the sensation of the hands. For example, it may be difficult to feel and recognise objects in the usual way and you may have a tendency to drop things.

Problems with your bladder. For example, you may experience problems with emptying your bladder, or incontinence.
A doctor's examination may show changes to the sensation, power and tendon reflexes to the legs and arms. You are likely to be referred to a specialist for further tests, usually an MRI scan. This will show how the spinal cord is affected and whether any surgical treatment to relieve the pressure is likely to help.


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