Health Encyclopedia

Cervical spondylosis

Definition

Cervical spondylosis is a disorder caused by abnormal wear on the cartilage and bones of the neck (cervical vertebrae). The tissue wears away (degeneration) and mineral deposits form in the cushions between the vertebrae (cervical disks).

Alternative Names

Cervical osteoarthritis; Arthritis - neck; Neck arthritis

Causes, incidence, and risk factors

Cervical spondylosis is caused by chronic wearing away (degeneration) of the cervical spine, including the cushions between the neck vertebrae (cervical disks) and the joints between the bones of the cervical spine. There may be abnormal growths or "spurs" on the the bones of the spine (vertebrae).

These changes caused by degeneration can over time press down on (compress) one or more of the nerve roots. In advanced cases, the spinal cord becomes involved. This can affect not just the arms, but the legs as well.

A previous neck injury (which may have occurred several years before) can make a person more likely to develop spondylosis, but the major risk factor is aging. By age 60, 70% of women and 85% of men show signs of cervical spondylosis on x-ray.

Symptoms

Headaches, particularly in the back of the head
Loss of balance
Loss of control over the bladder or bowels (if spinal cord is compressed)
Loss of sensation or abnormal sensations of the shoulders, arms, or (rarely) legs
Neck pain (may radiate to the arms or shoulder)
Neck stiffness that gets worse over time
Weakness of the arms or (rarely) legs

Signs and tests

Examination often shows limited ability to bend the head toward the shoulder and rotate the head.

Weakness or loss of sensation can be signs of damage to specific nerve roots or to the spinal cord. Reflexes are often reduced.

The following tests may be done:

CT scan or spine MRI
EMG
Spine or neck x-ray
X-ray of the lower (lumbar) spine
X-ray or CT scan after dye is injected into the spinal column (myelogram)

Treatment

The goal of treatment to relieve pain and prevent permanent spinal cord and nerve root injury.

In mild cases, no treatment is required. Symptoms from cervical spondylosis usually stabilize or get better with simple, conservative therapy, including:

A cervical collar (neck brace) worn for a short period of time to restrict motion
Cortisone injections to specific areas of irritation
Nonsteroidal anti-inflammatory medications (NSAIDs)

Periods of neck traction may be recommended, but this therapy has not been found to be helpful most of the time.

Severe cases may need hospitalization with complete bedrest and traction for 1 or 2 weeks. Narcotic medicine or muscle relaxants may help to reduce pain. Surgical decompression of the spinal cord in the neck may be recommended for severe pain or significant loss of movement, sensation, or function.

Surgical procedures may remove bone and disk tissue that is pressing on the nerves of the spinal cord, or stabilize the neck by fusing the cervical vertebrae.

Expectations (prognosis)

Most patients with cervical spondylosis will have some long-term symptoms. However, they respond to non-surgical treatments and do not need surgery.

Complications

Chronic neck pain
Inability to hold in feces (fecal incontinence) or urine (urinary incontinence)
Progressive loss of muscle function or feeling
Permanent disability (occasional)

Calling your health care provider

Try home treatments, such as the use of a cervical collar (which you can buy at pharmacies) and over-the-counter pain medications.

Call your health care provider if:

The condition becomes worse
There are signs of complications
You develop new symptoms (such as loss of movement or sensation in an area of the body).

Prevention

Many cases are not preventable. Preventing neck injury (such as by using proper equipment and techniques when playing sports) may reduce your risk.

References

Feske SK, Cochrane TL. Degenerative and compressive structural disorders. In: Goetz CG. Goetz: Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 29.

Polston DW. Cervical radiculopathy. Neurol Clin. 2007;25:373-385.

Review Date:5/5/2008
Reviewed By:Andrew L. Chen, MD, MS, Orthopedic Surgery and Sports Medicine, The Alpine Clinic, Littleton, NH. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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