Definition

[1]
Cervical spondylosis is the progressive degeneration of the cervical spine which affects bone as well as intravertebral discs. It may be asymptomatic or cause spinal cord compression.

Incidence

[2]
Nearly all patients above the age of 40 have the consition but very few have symptoms. Only 1-2% of patients will ever require surgical intervention

Age

>40

Gender

Equal in males and females

Aetiology

[3]
  • Age related degeneration
  • Trauma
  • Genetics

Risk Factors

[4]
  • Age
  • Truama
  • Family history

Signs and Symptoms

[5]

Pathophysiology

[6]
The cervical spine is made of cartilaginous discs and synovial facet joints. With age the disc becomes dehydrated and the joint space begins to narrow and osteophytes may begin to develop. The degeneration of the discs also increases loading on the facet joints.

In most people cervical spondylosis has no effect except, perhaps, for a reduction is cervical spine movement; however, some patients develop axial neck pain, even with limited changes radiographically. Nerve compression may due to mild degenerative changes alone or stenosis of the intravertebral foramina. Cervical spondylosis may be exacerbated by other spinal changes such as an exaggerated kyphosis or Ankylosing Spondylysthetis.

Investigations

[7]
Include expected results

Imaging

  • Cervical X-ray - degenerative changes
  • Cervical MRI - degenerative changes and possible nerve or spinal cord involvement

Diagnosis

[8]
Diagnosis may be made clinically or by incidental finding on imaging.

Differentials to rule out

Treatment

[9]

Non-Pharmacological

  • Physiotherapy

Pharmacological

Surgical

  • Surgical decompression

Management

[10]
Monitoring depends on the severity of the patients symptoms.

Complications

[11]
  • Progressive degeneration

Prognosis

[12]
Axial pain has no cure and continues to worsen with degeneration. Nerve compression; however, may resolve itself and can also respond well to surgical treatment.

See Also

Oxford Handbook of Clinical Medicine - 9th edition p512
BMJ Best Practice - Degenerative cervical spine disease

The spine includes 2 basic cartilaginous joints: the disc, which initially contains a complex hydrogel material, and the facet joints, which are synovial joints. [8]
The disc hydrogel is poorly maintained with maturity due to the loss of the primary disc cells (which maintain the hydrogel) and sclerosis of the end plates (preventing diffusion of nutrients). The disc joint becomes dehydrated and narrows. View image At a certain degree of narrowing, the annulus of the disc, which is normally without nerve endings, can become innervated and develop osteophytes at the margins, similar to any type of mobile joint. Because the function of the facet joints is primarily prevention of rotation and flexion/extension, their degeneration is enhanced with more axial loading as the disc joint narrows, placing more stress on the facet joints.
The cervical joint degeneration or spondylosis is entirely asymptomatic in many people, except perhaps for decreased cervical range of motion. [1] [4]
However, a number of patients experience axial neck pain with mild degenerative changes (i.e., limited joint narrowing only). [16] View image For this reason, the degree of spondylosis on cervical radiographs or MRI does not necessarily correlate with the syndrome of axial neck pain. [1] [4] [17] The perception of the pattern of pain with cervical spondylosis is that the joint receptor signals (including those of abnormal nerve fibres innervating the annulus with degeneration) are routed to cervical paraspinal muscles in particular, resulting in paraspinal muscle spasm and characteristic interscapular and lateral neck pain. [2] [6] [7] Idiopathic axial neck pain, such as that occurring with degenerative changes, demonstrates a poorer outcome than that associated with a specific cause. [18]
Cervical spondylotic radiculopathy (CSR) results if the nerve exiting the spinal cord and the spinal canal is pinched by either disc degeneration alone (i.e., herniated disc, wherein an annular weak spot allows displacement of disc nucleus contents to be adjacent to the nerve root) or with moderate to severe degenerative changes, narrowing the root exit at the foraminal level. [19] [20] View image
Cervical spondylotic myelopathy (CSM) usually involves severe disc and facet degeneration with changes in the alignment of the spine, such as kyphosis or spondylolisthesis, along with osteophyte formation. These lead to a significantly narrowed spinal canal and secondary spinal cord deformation.

  1. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/577.html
  2. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/577.html
  3. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/577.html
  4. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/577.html
  5. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/577.html
  6. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/577.html
  7. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/577.html
  8. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/577.html
  9. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/577.html
  10. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/577.html
  11. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/577.html
  12. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/577.html