Cervical Spondylosis

What is a Cervical Spondylosis?

The term Cervical Spondylosis describes the age-related degeneration of the cervical vertebrae cushions, or spinal disks. Degeneration of the disks and compression of the nerves leaving the spinal canal are the results.

It usually appears in adults over 40 as a result of aging naturally and repeated strain on the neck over time. However, younger people can also experience it as a result of injury. Bone spurs, also known as osteophytes, frequently grow around the vertebrae to compensate for the degeneration and height loss of the cervical disks, which can reduce the area available for nerves.

Frequent signs and symptoms include stiffness in the neck that travels to the arms or shoulders. Compression of nerves can also result in numbness, tingling, or weakness in the limbs. Genes associated to aging and the long-term effects of repetitive neck strain from sports or work are major risk factors. An additional factor is bad posture. The major objectives of treatment are reduced pain and improved function. When nerve compression is severe, treatment options may include surgery, medication, physiotherapy, exercise, neck braces, and traction devices. Maintaining good posture and neck flexibility can help prevent cervical spondylosis from progressing.

Anatomy:

Vertebral Types:

The cervical spine is made up of vertebrae numbered C1 through C7, arranged top to bottom. Some of them are;

• C1: The atlas permits side-to-side movement and helps in supporting the skull.

• C2: The axis features a slight protrusion that allows for pivoting and allows the head to rotate.

• C3–C6: The normal cervical vertebrae support the neck and provide flexibility.

• C7: The cervical and thoracic spines are joined by the vertebra prominens.

Ligaments:

• Ligaments restrict excessive motion and offer stability.
• Ligaments extending longitudinally line the surfaces of the vertebral bodies on the inside and outside.
• The ligamentum vivum connects to the next vertebrae’s lamina.
• The spinous processes are joined by the ligamentous processes.
• The facet joints are surrounded by the capsular ligaments.

Nerves:

• By means of the vertebral foramen, which the vertebrae form, the cervical nerves leave the spinal cord.
• Relevantly numbered vertebrae are above where nerve roots emerge.
• Nerves control muscles, sensations, and reflexes in the diaphragm, arms, shoulders, and neck.
• Pain, tingling, numbness, and weakening in the muscles can all be results of compression.

Causes:

The neck and backbone’s supporting tissues progressively weaken with aging. Among these changes are;

Degenerative/Aging Changes

• The cervical spine’s intervertebral discs thin and lose moisture as we age, which causes disc degeneration. This process starts to happen about age 40.
• The body attempts to stabilize the cervical segments by flattening the discs and maybe forming osteophyte bone spurs. Nerves and the spinal canal are compressed as a result.
• As people age, cartilage loss-related facet joint degeneration also worsens and exacerbates symptoms.

Herniated disks

• The outside of the spinal disks also has cracks. A disk’s soft interior can seep through these gaps. At times, it exerts pressure on the nerve roots and spinal cord.

Bone spurs

• The body may overproduce bone when the disks degrade in an attempt to incorrectly reinforce the spine. The spinal cord and nerve roots may occasionally be pinched by these bone spurs.

Dehydrated disks

• Between the vertebrae of the spine, disks function as cushions. It is often seen that around the age of forty, spinal disks start to breakdown and dry up. Bone-on-bone contact between vertebrae increases with the size of the disks.

Relative Stress and Chronic Injury

• Timely disc and vertebral degeneration is accelerated by chronic repeated loading resulting from work-related stresses and bad neck postures.
• Sports-related trauma, pain from breaks down, and past trauma can potentially cause early cervical changes.

Signs and symptoms:

Cervical spondylosis may result in the following symptoms;

• Pain in the neck that could radiate to your shoulders or arms
• A headache
• An uncomfortable feeling when your neck is moved
• It feels like your legs and arms are weakened.
• Tingling in your hands, arms, or shoulders
• Stiffness in the neck
• Having difficulty staying balanced
• Difficulty managing your bowels or bladder

Risk factor:

Certain variables can increase the risk of cervical spondylosis.

• Age : Elderly people frequently develop cervical spondylosis.

• Injury to the neck : Cervical spondylosis risk appears to be increased by previous neck traumas.

• Occupation: The neck is more stressed in jobs that require a lot of overhead work, poor posture, or repetitive neck movements.

• Genetic factors. Over time, some members of specific families will undergo more of these modifications.

• Smoking. Elevated neck pain has been associated with smoking.

Diagnosis:

Physical examination:

Your doctor will assess your general health and medical history before doing a comprehensive examination of your arms, shoulders, legs, and often your neck.

They’ll run a number of tests to check for issues or modifications in;

• Your hands, fingers, and arms are strong.
• Touch sensation Responses
• Blood circulation
• Your arms and neck should be flexible.
• Gait, or manner of walking

In order to feel for trigger points or irritated glands, your doctor may also lightly push on your neck and shoulders. They will also question you to get additional information about your symptoms and any possible neck problems.

Tests:

You will receive a physical examination from your  doctor to determine whether this ailment. It is likely that you will talk about any past neck injuries and explain your current symptoms. Your arms, legs, shoulders, and neck will likely be examined by the medical professional to see how well they are functioning.

Other examinations that could help in a diagnosis consist of;

CT Scan

• Clarify which bone diseases, such as facet arthropathy, are causing the symptoms.
• Normally ordered for further description following an MRI

Myelography

• The purpose of this test is to see how the bone spurs and disks are interacting with the various nerves. 
• A doctor will first inject a dye into the fluid surrounding your spinal cord and then do a CT scan.

X-ray

• First imaging examination to evaluate the development of bone spurs, disc space narrowing, and misalignments.
• It is possible to see foraminal stenosis and spinal canal diameter using AP, lateral, and oblique views.
• Views that flex or extend verify stability

Electromyography

• This exam measures the degree of effectiveness with which your nerves transmit signals from your spinal cord to your muscles.

MRI

• An imaging test that is gold standard
• Makes the spinal cord, nerve roots, and intervertebral discs visible.
• Determines how much of a nerve or cord is impacted
• Examine the soft tissue compression sources.

Treatment:

Non surgical treatment

Medicine

• Acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs): For pain and inflammation.
• Treating acute muscle spasms with muscle relaxants (e.g., tizanidine, cyclobenzaprine).
• Nerve painkillers (pregabalin, gabapentin): For radicular discomfort.
• Inflammation is reduced by steroids (local epidural injections, oral prednisone).

Physiotherapy

• Manual therapy methods include: Apply pressure, draw, or work with it.
• Workouts for neck stabilization and posture improvement.
• Stretching and range-of-motion exercises.
• Pain management with heat and ice therapy.
• Either electrical or ultrasound stimulation.

Cervical collar

• Cervical collars, whether flexible or stiff, offer support and prevent uncomfortable movements.
• Recommended following surgical therapy or for severe strains

Injections

• When other treatments fail to relieve a patient’s pain, injections such spinal epidurals or corticosteroids may be able to help. Injections of steroids can be administered via facet joints or trigger points.

Changes in Lifestyle

• Ergonomic modifications at work.
• Frequent exercise for cervical stability and weight control.
• Correct habits for standing and sitting posture.
• Compresses, either cold or warm, to relieve symptoms.

Surgical Treatment

For cervical spondylosis and neck pain, surgery is typically not advised unless your doctor concludes that;

• A herniated disk or bone pinching a spinal nerve causes cervical radiculopathy.
• You’re spinal cord has been compressed (cervical spondylotic myelopathy).

Surgery is more likely to be beneficial for patients who develop progressive neurologic symptoms, such as numbness, arm weakness, unstable walking, or falls.

In certain cases, if nonsurgical treatment has failed to relieve severe neck pain (without nerve compression), surgery may be advised. Surgery may not be an option for certain people with severe neck discomfort, though. Their arthritis’s extensive nature, additional health issues, or other painkillers like fibromyalgia could be to blame for this.

Physiotherapy management:

A key component of conservative treatment for cervical spondylosis is physical therapy. Its main goals are pain relief, range of motion improvement , posture correction, and improved functional mobility of the upper extremities and cervical spine.

Manual Therapy

Practical methods for releasing tense muscles and joints and improving range of motion in restricted spinal segments.

Typical strategies:

• Massage: Releases stiff muscles that are causing discomfort.
• Release of trigger points: focuses on tense muscles that restrict movement
• Traction: Lightweights or pulleys gently compress the spine.
• Low-speed spinal procedures that involve joint mobilization

Posture-related Instruction

• Posing with the body, shoulders, and neck in the optimal alignment
• Avoiding tense, repeated positions that exacerbate symptoms
• Evaluation of workplace ergonomics
• Braces for posture can give signs.

Electrotherapy modalities

Interferential Current Therapy(IFT)

• Target tissues are crossed by two alternating medium-frequency currents.
• Encourages the transfer of calcium and sodium ions, resulting in better healing.
• lessens muscle spasms and post-exercise discomfort

Transcutaneous Electrical Nerve Stimulation (TENS)

• Reduces neck and radicular pain from spondylosis by transcutaneous electrical nerve stimulation (TENS), which blocks pain impulses to the brain and produces endorphins that reduce pain.
• TENS applies a low voltage electrical current to places that are painful.

Exercise for Cervical Spondylosis:

Neck roll

• First, settle into a comfy chair.
• As soon as your neck muscles start to expand a little, turn your head to the right.
• After a few seconds, slowly turn your head clockwise.
• Hold for a little minute after you reach your left shoulder side.
• Once more, your neck muscles ought to feel slightly stretched.
• Complete the rotation in a clockwise manner.
• Then return to your neutral position.
• Then relax.
• Repeat this exercise five to ten times.

Neck Isometrics

• Start by taking a comfortable seat.
• Place your hand over your forehead.
• Try to resist the pull by using your neck muscles.
• Hold on for a short while.
• Return to the neutral position after that.
• Next, relax.
• Applying pressure on the side of your head.
• Now, change sides.
• pressing into the back of your head.
• Perform this exercise again.
• Then return to your neutral position.
• Then relax.
• Repeat this exercise five to ten times.

Shoulder roll

• To get started, take a comfortable seat.
• Maintain a comfortable posture with your arms.
• Elevate your shoulders in contrast to your ears.
• Squeezing the shoulders together can be facilitated by pushing them back.
• Hold this position for a few seconds.
• Then return to your neutral position.
• Then relax.
• Repeat this exercise five to ten times.

Upper Trapezius Stretch

• First, settle into an easy chair.
• Cover the right side of your head with your left hand.
• Press down with carefully.
• Put pressure on the part of your head that corresponds with your shoulder.
• Hold this position for a few seconds.
• Then return to your neutral position.
• Then relax.
• Repeat this exercise five to ten times.

Prevention:

Cervical spondylosis may not be preventable, however you can lower your risk by following these recommendations;

Make use of ergonomic tools

• To encourage improved posture and less strain on the neck, make use of ergonomic workstations, chairs, keyboards, phone headsets, and other devices.
• Maintain eye level with computer screens to prevent bending your neck.

Keep your posture upright

• Maintain a straight neck and head alignment over your shoulders whether you’re sitting, standing, or lying down. Stay away of hunching over phones, desks, or books.

Apply the hot/cold combination

• To promote blood flow and reduce spasms in sore or inflamed neck muscles, apply ice and heat packs.

Engage in regular exercise

• To provide yourself extra support, engage in strength training for your back, neck, and core muscles. Low-impact aerobic exercise also improves spinal flexibility and helps with weight management.

Control your stress levels

• Regular relaxation exercises will help you avoid tensed, stiff muscles caused by chronic stress. As tiredness also increases tense muscles, get enough sleep.

Do not smoke

• To maintain the cervical spine, give up smoking and tobacco usage. Smoking restricts spinal blood flow and hastens age-related degradation.

Summary:

The joints and discs of your cervical spine, which is located in your neck, are impacted by the frequent age-related disorder known as cervical spondylosis. This condition is sometimes referred to as cervical osteoarthritis and neck arthritis. It appears as a result of degeneration of the bones and cartilage. Although age plays a major role, other things can also contribute to it.

Usually, it starts out as stiffness and soreness in the neck, with referral patterns into the head, shoulders, and upper back probable. As it progresses, more intense compression causes cervical radiculopathy, which is characterized by tingling and numbness that radiates into the dermatomal pattern and arm pain. Serious instances may result in cervical myelopathy, which manifests as hyperreflexia, trouble balancing, and dexterity problems, all of which point to spinal cord involvement.

Inline clinical observations and radiographic evidence of degeneration provide the foundation for the diagnosis. The cornerstones of initial management include anti-inflammatory medications, physiotherapy for improving posture and mobility, and maybe epidural injections for pain relief.

FAQ:

References:

• Mayo Clinic: Symptoms and Causes of Cervical Spondylosis (2023, November 18). The Mayo Clinic. The Mayo Clinic website describes cervical spondylosis symptoms, causes, and treatment (Syc-20370787).

• OrthoInfo – AAOS – Cervical Spondylosis (Arthritis of the Neck) (n.d.). https://orthoinfo.aaos.org/en/diseases-conditions/neck-arthritis-cervical-spondylosis/

• 2024, January 19; Delgado, A. Healthline. https://www.healthline.com/health/cervical-spondylosis.

• A. Virani (2024, Feb. 22). the reasons behind cervical spondylosis, how to treat it, and how to avoid it. Exercise and Physical Therapy Treatment. Physical-therapy.us/conditions/cervical-spondylosis

• March 3, 2023: Felman, A. Important information on cervical spondylosis. /articles/172015 on Medical News Today

• Spinal spondylosis. 2021 August 8. Johns Hopkins Medicine. http://www.hopkinsmedicine.org/health/conditions-and-diseases/cervical-spondylosis#:~:text=Cervical%20spondylosis%20is%20a%20type,spondylosis%2C%20these%Twenty disks become compressed.

• Image 1, Health Narayana. (n.d.). Health Narayana. https://www.narayanahealth.org/diseases/spondylosis of the cervical region

• Image 2, The cervical spine is covered in Know Your Neck (n.d.). Health System of Saint Luke. Know your cervical spine’s neck anatomy at https://www.saintlukeskc.org/health-library/

• Image 3, C. W. Thane (2017) 19 December. Chikittsa Wellness Thane: Isometric Exercises for Neck Support – Medium. @chikittsawellnessthane on Medium: “Isometric Exercises for Neck Support” (8aef8849c229)

• Image 4, N. Surgery (2024, Feb. 21). Top Exercises for Patients with Parkinson’s Disease. Top Parkinson’s disease exercises can be found at https://neurologicalsurgery.in/blog/

• Image 5, August 18, 2020: Zarriello, A. Restore physical therapy is one of three ways to reduce shoulder impingement pain. Bring Back Physical Therapy. Here are three strategies to lessen shoulder impingement pain: https://www.restoreptri.com/blog/2020/8/18