Cervical Spondylosis Disease

BASICS

DESCRIPTION

Degenerative changes in the cervical vertebra and/or disk with spur formation and subsequent impingement of neural elements in a narrow cervical canal

System(s) affected: Musculoskeletal
Genetics: N/A
Incidence/Prevalence in USA: 30-40% of the population above age 40 years
Predominant age: Above 40 the incidence increases with each passing decade
Predominant sex: Male > Female (3:2)

SIGNS AND SYMPTOMS

Pain in the posterior neck often associated with radiation into the arms
Scapular pain
Pain in the arms is almost always on the outer aspect of the arm at least to elbow level (coronary heart pain is almost always on the inner aspect of the arm)
Radicular pain into the arms or scapular area may be present without neck pain
Dysphagia may develop with large anterior osteophytes
Weakness of extremities - upper and/or lower
Bladder or bowel incontinence in severe cases
If an osteophyte develops on a neurocentral joint and extends laterally, it can encroach on the vertebral artery and may cause dizziness, vertigo, tinnitus or interorbital blurring of vision. Symptoms are exacerbated by extremes of movement and even minor neck trauma.
Loss of neck extension (common)
Lateral flexion of the cervical spine is limited in the erect position, but greatly increased on lying down. (Functional disorders are not improved by lying down.)
Long tract signs may develop in severe cases with positive Babinski
Tenderness of biceps and pectoralis major in C5-6 segment disease
Triceps tenderness in C6-7 segment disease

CAUSES

Degenerative changes with osteophytes and disk space narrowing

RISK FACTORS

N/A

DIAGNOSIS

LABORATORY

N/A

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

N/A

SPECIAL TESTS

N/A

IMAGING

X-rays of cervical spine, AP, lateral open mouth odontoid and both oblique views should be obtained. Osteophytes and/or joint space narrowing will be evident.
CT or MRI scans are quite valuable in cases where surgery is contemplated or the diagnosis is in doubt. It is not indicated in the great majority of cases as a careful history and physical examination coupled with routine cervical spine x-rays will make the diagnosis. The decision as to which is better, the CT scan or MRI, is controversial. The MRI depicts cord changes, enlargement, compression, or atrophy better. While the CT, especially in conjunction with myelography, shows the bony changes, especially in foramina involvement. MRI has the obvious advantage of not requiring a myelogram. Postoperatively, the MRI is excellent in evaluation of patients who have failed to obtain relief from surgery or have developed new symptoms. If this does not demonstrate a cause, then a CT scan with contrast can be obtained.

DIAGNOSTIC PROCEDURES

N/A

TREATMENT

APPROPRIATE HEALTH CARE

Outpatient for conservative treatment, inpatient if surgery indicated

GENERAL MEASURES

Acute phase - moist heat, gentle massage and temporary immobilization with a cervical collar that holds the neck in slight flexion. Intermittent cervical traction may be helpful, but the line of pull should be such that the neck is slightly flexed. Ultrasonic treatments, especially combined with gentle muscle stimulation (US-MS) for 15-20 minutes daily or bid may be helpful in the acute phase.
Chronic - no treatment necessary except for non-narcotic analgesics for symptoms. Any type of activity or work which causes strain of the neck should be avoided.

SURGICAL MEASURES

Indications: Severe pain unresponsive to conservative measures, significant or progression of neurologic deficits, long tract signs, vertebral artery syndrome
Most common surgery is anterior interbody fusion with excision of disk and any accessible osteophytes

ACTIVITY

Any activity which does not cause symptoms should be encouraged as the disease is chronic. Needless restrictions can make the patient a medical invalid.

DIET

No special diet

PATIENT EDUCATION

Personally instruct (or have a therapist instruct) in the proper use of orthopedic appliances. Cervical collars should produce a slight flexion of the neck as should traction. Avoid extension in all situations.
Instruct patient in home traction to relieve symptoms; instruct patient in home exercise routine to relieve spasm and discomfort
Instruct patients to report any weaknesses, eye symptoms, bladder or bowel incontinence immediately

FOLLOW UP

PREVENTION/AVOIDANCE

The midcervical spine is the area usually involved in spondylosis. This portion will develop a flexion deformity causing extension of the upper spine as the body tries to keep the head erect. Avoid any extension strain such as a "spinal manipulation," extension during intubation for a general anesthesia, or cervical strain from auto accidents, especially rear-end collisions. These can cause a basilar artery thrombosis or thrombosis of the posterior inferior cerebellar artery with a subsequent Wallenberg's syndrome. Dysphagia, pain and temperature loss to the same side of the face and opposite side of the body, nystagmus and Horner's syndrome are present in Wallenberg's syndrome.

POSSIBLE COMPLICATIONS

Loss of motion, especially extension, may require adjustments to certain occupations to prevent uncommonly significant muscle loss and instability of gait, bladder or bowel function

EXPECTED COURSE AND PROGNOSIS

Fortunately, the prognosis is for a benign course in the overwhelming majority of cases, though for most of their lives patients will be plagued by pain which exacerbates often with no known cause

MISCELLANEOUS

ASSOCIATED CONDITIONS

Cervical disk disease

AGE-RELATED FACTORS

Pediatric: N/A
Geriatric: N/A
Others: N/A

PREGNANCY

As in the case of rheumatoid arthritis, the symptoms often improve but occasionally are made worse

OTHER NOTES

N/A

ABBREVIATIONS

US-MS = ultrasonic treatment with muscle stimulation

Clinical Investigations

ROLE OF HOMOEOPATHY

Holistic healing that treats the person, not just the disease. Experience gentle, lasting wellness with expert constitutional care.