Cervical Spondylosis

Video

Western Health Orthopaedic Registrar presentation – Cervical Spondylosis, Radiculopathy & Myelopathy by Dr James Churchill

Victorian Bone School Presentation – Cervical Spondylosis & Ankylosing Spondylitis

Definition

  • Degeneration of lower cervical levels with loss of disc height, lipping of vertebral bodies (spondylophytes) & degeneration of intervertebral joints

Aetiology

Epidemiology

  • More than 80% of the British population over 55 years have cervical spondylosis

Anatomy

Pathology

  • Encroachment
    • Osteophyte formation from the:
      • facet joints
      • margins of the joints of Luschke
    • spondylophytes from the
      • vertebral body margin
  • Rarely osteophytes develop on the neurocentral lip which may encroach on the vertebral artery
    • resulting in vertebral artery syndrome of
      • dizziness
      • vertigo
      • tinnitus
      • blurring of vision

Classification

History

  • Patient usually over 40 years
  • History
    • Pain
      • Complains of neck pain of gradual onset often worse in the morning
      • Pain may radiate widely to the occiput, shoulder & arm
    • Decreased Movement
      • First movement to be lost is extension & may have marked limitation of lateral flexion when upright which improves on lying down
    • Neurological
      • Paraesthesia, weakness & clumsiness are occasionally features

Examination

  • May have tenderness of cervical musculature
  • movements may be limited by pain
  • very rarely may have signs of a cervical myelopathy with brisk reflexes in the lower limbs & ↑ tone

Investigations

  • Xray
    • Reduced disc height
    • Cervical spondylosis (lipping of vertebrae & spondylophytes)

Differential Diagnosis

  • Referred pain:
    • Cervical disc degeneration (? not painful)
    • Apical tumours (Pancoast syndrome, Horners & pain down the arm)
    • Thalamic lesions (very uncommon)
    • Thoracic outlet syndrome
  • Local lesions:
    • Carpal tunnel syndrome
    • Neuralgic amyotrophy (brachial neuritis)
    • Shoulder problems (AC joint, rotator cuff, Glenohumeral arthritis etc)

Treatment

  • Nonoperative
    • Rest analgesics & anti-inflammatories
    • A cervical collar may be necessary at times of acute episodes
    • Physiotherapy & local modalities
  • Operative
    • Decompression
      • If associated with radicular symptoms or myelopathy may require decompression
    • Fusion
      • In some cases cervical fusion may be indicated in the absence of radicular symptoms

Complications

Prognosis

  • Restriction of movement usually persists but the discomfort resolves as time passes
  • Many people have similar X-Ray changes with no or little discomfort at any stage in their life
  • In dealing with predominant neck pain in the absence of neurological deficit & discrete radicular symptomatology the results of surgery do not significantly alter the natural history

References