Cervical spondylosis- Causes, Symptoms & Treatment-2020

Cervical spondylosis
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Cervical spondylosis

Cervical spondylosis is the condition in which there are degenerative changes in the inter-vertebral joints between the bodies  and disk in the cervical spine.

In early stage, it is localised in 2-3 cervical vertebrae region due to degeneration of the intervertrbral disk and there  is narrow osteophytes formation of the anterior and posterior margins of the spine and thee osteophytes  causes narrowing of intervertebral foramen resulting in nerve root irritation (in later stages)

It occurs early in persons involved in “white collar jobs” or those susceptible to neck strain because of keeping the neck constantly in one position while reading or writing.

Incidence

Middle-aged and elderly (30-45 years of age) women and men. Particularly, in those occupation which involves a psotures of prolonged neck flexion.

Etiology

Poor posture associated with anxiety habit occupation stress ( involves) a posture of prolonged neck flexion. Typists of poorly positioned desks, writer, drivers, holding telephone on one shoulder,sleeping in awkward conditions.

Pathogenesis

Degeneartion of disk results in reduction of disk space and peripheral osteophyte formation. The psoterior intervertebral joints get secondarily involved and generate pain in the neck. The osteophytes impinging on the nerve roots give to radicular pain in the upper limb.

 Essentials of Diagnosis

  • Generalized disease of the cervical spine related to disk degeneration; myelopathy, radiculopathy, or both may occur.
  • In 90% of men >50 y and women >60 y, radiographs show cervical degeneration: disk changes, then facet arthropathy, and osteophyte formation and ligament instability.
  • Patients often present with complaints of shoulder, elbow, wrist, or hand pain and may report headache (if upper cervical spine is affected) and stiff neck.
  • Multiple nerve roots may be involved in radicular symptoms, causing arm pain and distal paresthesias.
  • Myelopathy may present with radicular symptoms but also loss of balance, broad-based gait, and lower extremity weakness.
  • Reflexes are hypoactive in the upper extremity but hyperactive in the lower; possible Babinski reflex and clonus.
  • Clinical picture depends on the anatomic level involved.
  • On lateral radiographs, the space available for cord (SAC) is measured from the posterior-inferior aspect of the vertebral body to the anterior aspect of the spinous process at the vertebra below; normal SAC is 17 mm; relative stenosis is SAC of 10–13 mm; absolute stenosis is SAC of <10 mm.

 Differential Diagnosis

  • Cervical radiculopathy due to cervical disk
  • Spinal cord tumor
  • Rheumatoid arthritis
  • Multiple sclerosis
  • Syringomyelia

Treatment

  • Depends on symptoms (eg, neck pain alone, radiculopathy, or myelopathy); initial management is soft collar, NSAIDs, and physical therapy; epidural steroids may be helpful.
  • Consider surgical intervention if unresponsive to conservative therapy or if neurologic status deteriorates; surgical decompression of cord through an anterior approach allows anterior fusion; cervical disk replacement is probably not appropriate for the generalized disease occurring in spondylosis.

Pearl
Cervical myelopathy is the most common form of spinal cord dysfunction in people older than 55 y

Clincal features

 Pain

  • Headache due to upper cervical pathology
  • Neck ache due to middle cervical pathology
  • Shoulder girdle, shoulder and arm pain due to pathology from C4 to T2 ( radiating pain )

Neck postural muscles are often weak

Tenderness in the cervical spine present

Limitation of all movement of cervical spine

Investigation

X-rays:

  • Osteophytes formation ( new growth)
  • Narrowing of joint space
  • Narrowing of intervertebral foramen

Treatment: Physiotherpahy

Relief of pain:

  • Analgesics,SWD to neck and intermittent cervical traction
  • Shoulder bracing and neck exercise
  • Use of cervical collar (in acute and extremely painful condition)

Local Contraindication

Pulmonary tuberculosis (TB)

Hearing aids

Vertebrobasillar insufficiency-for giddiness

Any skin Diseases

Abscess

Recent injury

Positioning of the patient

Arm lean sitting (neck and shoulder should be in neutral position)

Placement of electrodes

Monoplanar technique: For localized pain

Coplanar technique: For radiating pain

Spacing: Narrow

Dosage:

  • Acute: Subthermal
  • Subacute: Mildthermal
  • Chronic: Thermal

Duration:

  • Acute:10-15 minutes
  • Subacute:15-20 minutes
  • Chronic- 20-30 minutes

Home instructions

Isometric neck exercise

Shoulder bracing exercise

Advise not to use pillows

Advise not to be flex the hand

Teach how to read the books

Cervical collar shoulder be used daily

Cervical collar should not worn during sleeping,Bathing

Cervical pillow (made of resin,like roll of towel) can be used

Contour pillows can be used

Advise not to take cold water bath only hot water bath can be taken

Advise not to carry weight over the head

Advise not to take frequent head bath

While travelling, advise to sit in middle and on front seats

While climbing or getting down, ask the patient to nkeep the neck in neutral position

Advise not be use two wheelers on rough roads

Effects: Relief pain

 


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