CERVICAL SPONDYLOSIS

Cervical spondylosis is a general term for age-related wear and tear affecting the spinal disks in your neck. As the disks dehydrate and shrink, signs of osteoarthritis develop, including bony projections along the edges of bones (bone spurs).

Cervical spondylosis is very common and worsens with age. More than 85 percent of people older than age 60 are affected by cervical spondylosis.

Most people experience no symptoms from these problems. When symptoms do occur, nonsurgical treatments often are effective.

Other names are arthritis of the neck, cervical osteoarthritis, or degenerative osteoarthritis.

Causes

The bones and protective cartilage in your neck are prone to wear and tear which can lead to cervical spondylosis. Possible causes of the condition include:

Bone spurs

These overgrowths of bone are the result of the body trying to grow extra bone to make the spine stronger.

However, the extra bone can press on delicate areas of the spine, such as the spinal cord and nerves, resulting in pain.

Dehydrated spinal discs

Your spinal bones have discs between them, which are thick, padlike cushions that absorb the shock of lifting, twisting, and other activities. The gel-like material inside these discs can dry out over time. This causes your bones (spinal vertebrae) to rub together more, which can be painful.

This process can begin to happen in your 30s.

Herniated discs

Spinal discs can develop cracks, which allows leakage of the internal cushioning material. This material can press on the spinal cord and nerves, resulting in symptoms such as arm numbness as well as pain that radiates down an arm. Learn more about herniated discs.

Injury

If you’ve had an injury to your neck (during a fall or car accident, for example), this can accelerate the aging process.

Ligament stiffness

The tough cords that connect your spinal bones to each other can become even stiffer over time, which affects your neck movement and makes the neck feel tight.

Overuse

Some occupations or hobbies involve repetitive movements or heavy lifting (such as construction work). This can put extra pressure on the spine, resulting in early wear and tear.

Risk factors

Risk factors for cervical spondylosis include:

• Age: Cervical spondylosis is a normal part of aging.
• Occupation: Jobs that involve repetitive neck motions, awkward positioning or a lot of overhead work put extra stress on your neck.
• Neck injuries: Previous neck injuries appear to increase the risk of cervical spondylosis.
• Genetic factors: Some individuals in certain families will experience more of these changes over time, while others will not.
• Smoking: Smoking has been linked to increased neck pain.

Symptoms

• Neck stiffness and pain.
• Headache that may originate in the neck.
• Pain in the shoulder or arms.
• Inability to fully turn the head or bend the neck, sometimes interfering with driving.
• Grinding noise or sensation when the neck is turned.

Diagnosis

Your doctor will likely start with a physical exam that includes:

• Checking the range of motion in your neck
• Testing your reflexes and muscle strength to find out if there's pressure on your spinal nerves or spinal cord
• Watching you walk to see if spinal compression is affecting your gait

Imaging tests

Imaging tests can provide detailed information to guide diagnosis and treatment. Your doctor might recommend:

• Neck X-ray: An X-ray can show abnormalities, such as bone spurs, that indicate cervical spondylosis. Neck X-ray can also rule out rare and more serious causes for neck pain and stiffness, such as tumors, infections or fractures.
• CT scan: A CT scan can provide more detailed imaging, particularly of bones.
• MRI: MRI can help pinpoint areas where nerves might be pinched.
• Myelography: A tracer dye is injected into the spinal canal to provide more detailed X-ray or CT imaging.

Nerve function tests

Your doctor might recommend tests to determine if nerve signals are traveling properly to your muscles. Nerve function tests include:

• Electromyography: This test measures the electrical activity in your nerves as they transmit messages to your muscles when the muscles are contracting and at rest.
• Nerve conduction study: Electrodes are attached to your skin above the nerve to be studied. A small shock is passed through the nerve to measure the strength and speed of nerve signals.

Treatment

Treatment for cervical spondylosis depends on the severity of your signs and symptoms. The goal of treatment is to relieve pain, help you maintain your usual activities as much as possible, and prevent permanent injury to the spinal cord and nerves.

Medications

If over-the-counter pain relievers aren't enough, your doctor might prescribe:

• Nonsteroidal anti-inflammatory drugs: While some types of NSAIDs are available over the counter, you may need prescription-strength versions to relieve the pain and inflammation associated with cervical spondylosis.
• Corticosteroids: A short course of oral prednisone might help ease the pain. If your pain is severe, steroid injections may be helpful.
• Muscle relaxants: Certain drugs, such as cyclobenzaprine, can help relieve muscle spasms in the neck.
• Anti-seizure medications: Some epilepsy medications, such as gabapentin (Neurontin, Horizant) and pregabalin (Lyrica), can dull the pain of damaged nerves.
• Antidepressants: Certain antidepressant medications have been found to help ease neck pain from cervical spondylosis.

Therapy

A physical therapist can teach you exercises to help stretch and strengthen the muscles in your neck and shoulders. Some people with cervical spondylosis benefit from the use of traction, which can help provide more space within the spine if nerve roots are being pinched.

Surgery

If conservative treatment fails or if your neurological signs and symptoms — such as weakness in your arms or legs — worsen, you might need surgery to create more room for your spinal cord and nerve roots.

The surgery might involve:

• Removing a herniated disk or bone spurs
• Removing part of a vertebra
• Fusing a segment of the neck using bone graft and hardware

Lifestyle and home remedies

Mild cervical spondylosis might respond to:

• Regular exercise: Maintaining activity will help speed recovery, even if you have to temporarily modify some of your exercises because of neck pain. People who walk daily are less likely to experience neck and low back pain.
• Over-the-counter pain relievers: Ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve) or acetaminophen (Tylenol, others) is often enough to control the pain associated with cervical spondylosis.
• Heat or ice: Applying heat or ice to your neck can ease sore neck muscles.
• Soft neck brace: The brace allows your neck muscles to rest. However, a neck brace should be worn for only short periods of time because it can eventually weaken neck muscles.