Cervical spondylosis

Cervical spondylosis is a disorder in which there is wear on the cartilage (disks) and bones of the neck (cervical vertebrae). It is a common cause of chronic neck pain.

Causes

Cervical spondylosis is caused by aging and  chronic wear on the cervical spine. This includes the disks or cushions between the neck vertebrae and the joints between the bones of the cervical spine. There may be abnormal growths or spurs on the bones of the spine (vertebrae).

Chronic

Chronic refers to something that continues over an extended period of time. A chronic condition is usually long-lasting and does not easily or quick...

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Over time, these changes can 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.

Everyday wear and tear may start these changes. People who are very active at work or in sports may be more likely to have them.

The major risk factor is aging. By age 60, most people show signs of cervical spondylosis on x-ray. Other factors that can make someone more likely to develop spondylosis are:

• Being overweight and not exercising
• Having a job that requires heavy lifting or a lot of bending and twisting
• Past neck injury (often several years before)
• Past spine surgery
• Ruptured or slipped disk

  Ruptured or slipped disk

  A herniated (slipped) disk occurs when all or part of a disk is forced through a weakened part of the disk. This may place pressure on nearby nerves...

  

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• Severe arthritis
• Small fractures to the spine from osteoporosis

  Small fractures to the spine from osteo...

  Compression fractures of the back are broken vertebrae. Vertebrae are the bones of the spine.

  

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Symptoms

Symptoms often develop slowly over time. But they may start or get worse suddenly. The pain may be mild, or it can be deep and so severe that you are unable to move.

You may feel the pain over the shoulder blade. It may spread to the upper arm, forearm, or fingers (in rare cases).

The pain may get worse:

• After standing or sitting
• At night
• When you sneeze, cough, or laugh
• When you bend the neck backwards or walk more than a few yards or more than a few meters

You may also have weakness in certain muscles. Sometimes, you may not notice it until your doctor examines you. In other cases, you will notice that you have a hard time lifting your arm, squeezing tightly with one of your hands, or other problems.

Other common symptoms are:

• Neck stiffness that gets worse over time

  Neck stiffness

  Joint pain can affect one or more joints.

  

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• Numbness or abnormal sensations in the shoulders or arms

  Abnormal sensations

  Numbness and tingling are abnormal sensations that can occur anywhere in your body, but they are often felt in your fingers, hands, feet, arms, or le...

  

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• Headaches , especially in the back of the head

  Headaches

  A headache is pain or discomfort in the head, scalp, or neck. Serious causes of headaches are rare. Most people with headaches can feel much better...

  

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Less common symptoms are:

• Loss of balance

  Loss of balance

  Dizziness is a term that is often used to describe 2 different symptoms: lightheadedness and vertigo. Lightheadedness is a feeling that you might fai...

  

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• Pain or numbness in the legs
• Loss of control over the bladder or bowels (if there is pressure on the spinal cord)

Exams and Tests

A physical exam may show that you have trouble moving your head toward your shoulder and rotating your head.

Your health care provider may ask you to bend your head forward and to each side while putting slight downward pressure on the top of your head. Increased pain or numbness during this test is usually a sign that there is pressure on a nerve in your spine.

Weakness or loss of feeling can be signs of damage to certain nerve roots or to the spinal cord.

A spine or neck x-ray may be done to look for arthritis or other changes in your spine.

Neck x-ray

A neck x-ray is an imaging test to look at cervical vertebrae. These are the 7 bones of the spine in the neck.

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MRI of the neck is done when you have:

• Severe neck or arm pain that does not get better with treatment
• Weakness or numbness in your arms or hands

EMG and nerve conduction velocity test may be done to examine nerve root function.

EMG

Electromyography (EMG) is a test that checks the health of the muscles and the nerves that control the muscles.

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Nerve conduction velocity

Nerve conduction velocity (NCV) is a test to see how fast electrical signals move through a nerve.

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Treatment

Your doctor and other health professionals can help you manage your pain so that you can stay active.

• Your doctor may refer you for physical therapy. The physical therapist will help you reduce your pain using stretches. The therapist will teach you exercises that make your neck muscles stronger.
• The therapist can also use neck traction to relieve some of the pressure in your neck.

  Neck traction

  Traction means pulling on part of the body. Most often, traction uses devices such as weights and pulleys to put tension on a displaced bone or joint...

   

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• You may also see a massage therapist, someone who performs acupuncture, or someone who does spinal manipulation (a chiropractor, osteopathic doctor, or physical therapist). Sometimes, a few visits will help with neck pain.
• Cold packs and heat therapy may help your pain during flare-ups.

A type of talk therapy called cognitive behavioral therapy may be helpful if the pain is having a serious impact on your life. This technique helps you better understand your pain and teaches you how to manage it.

Medicines can help your neck pain. Your doctor may prescribe nonsteroidal anti-inflammatory medicines (NSAIDs) for long-term pain control. Opioids may be prescribed if the pain is severe and does not respond to NSAIDs.

If the pain does not respond to these treatments, or you have a loss of movement or feeling, surgery is considered. Surgery is done to relieve the pressure on the nerves or spinal cord.

Outlook (Prognosis)

Most people with cervical spondylosis have some long-term symptoms. These symptoms improve with non-surgical treatment and do not need surgery.

Many people with this problem are able to maintain an active life. Some people will have to live with chronic (long-term) pain.

Possible Complications

This condition may lead to the following: 

• Inability to hold in feces ( fecal incontinence ) or urine ( urinary incontinence )

  Fecal incontinence

  Bowel incontinence is the loss of bowel control, causing you to pass stool unexpectedly. This can range from sometimes leaking a small amount of sto...

  

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  Urinary incontinence

  Urinary (or bladder) incontinence happens when you are not able to keep urine from leaking out of your urethra. The urethra is the tube that carries...

  

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• Loss of muscle function or feeling
• Permanent disability (occasionally)
• Poor balance

When to Contact a Medical Professional

Call your provider if:

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

  Loss of movement

  Muscle function loss is when a muscle does not work or move normally. The medical term for complete loss of muscle function is paralysis.

   

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• You lose control of your bladder or bowels (call right away)