Cervical Spondylosis: Symptoms, Causes and Treatment

cervico-brachial neuralgia symptoms

La cervical spondylosis is a degeneration of vertebrae of the neck and the discs between them, causing compression of the spinal cord.

This is a very common process associated with aging, approximately 85% of over 60s would be affected. Most of them have no symptoms.

The first signs that appear are usually impaired walking, pain and loss of flexibility in the neck.

Diagnosis of cervical spondylosis is based on clinical examination, as well as on top themedical imaging (radiography, scanner, MRI). Its management involves non-steroidal anti-inflammatory treatments, muscle relaxants, the temporary wearing of a flexible neck brace and compliance with certain lifestyle measures.

Un traitement surgical is sometimes needed to relieve spinal cord compression.

What is cervical spondylosis?

Cervical spondylosis is an age-related pathology. It is characterized by a degeneration of the cervical vertebrae, that is to say, they decompose and lose their solidity with aging.

The human organism, to remedy this degeneration, begins a bone repair process. It strengthens the vertebrae. But during this process, there is sometimes excessive activity in certain areas with the production of bony growths (excess bone). These latter are called “osteophytes”.

 

These osteophytes cause a narrowing of the spinal canal in the neck with compression of the spinal cord.

At the same time, the discs intervertebral become dehydrated, deteriorate and lose their elasticity. Which then leads to a progressive loss of their ability to cushion and absorb the various shocks and stresses that the cervical region continually experiences. As a result, stenosis of the spinal canal and, therefore, compression, worsens and dysfunctions of the spinal cord appear.

What causes cervical spondylosis?

With aging, the bones and cartilage of our body wear out and lose their strength and elasticity. Those who make up the spine are no exception to the rule!

THEcervical spondylosis is the main cause of cervical spondylosis by inducing the following changes:

  • Formation of osteophytes: During bone remodeling of the cervical vertebrae, a process that allows bone tissue to be renewed continuously, small growths can form in the spinal canal and compress the spinal cord. These osteophytes are sometimes visible on cervical radiography and are one of the main signs of spinal osteoarthritis.
  • Dehydration of intervertebral discs : the intervertebral discs are kind of cushions placed between the vertebrae which allow the various shocks to be absorbed and the stresses to be evenly distributed over the entire spine. Around the age of 40, they begin to deteriorate as they dry out, and to shrink. This promotes "bone-bone" contact and destroys the intervertebral joints.
  • Protrusion of the intervertebral discs: the degeneration of the discs, by affecting their outer part (fibrous ring), causes cracks. The inner part (gelatinous core) can then come out through these cracks (bulging disc) and press on the spinal cord or one of its nerve roots.
  • Stiffening of the ligaments: with age, the ligaments of the spine stiffen (especially the yellow ligament). This makes the neck less flexible and aggravates other phenomena.

 

To learn more about cervical spondylosis, see the following article.

 

What are the symptoms of cervical spondylosis?

Osteoarthritis, being a phenomenon of age-related degeneration, is very common. It affects around 10 million French people, 75% of whom suffer from it at the cervical level.

However, most of them are asymptomatic. Because, the spinal compression is usually not large enough to impair the functioning of the spinal cord or its nerve roots.

But sometimes, the narrowing of the spinal canal leads to significant spinal cord compression. This is where the clinical signs arise.

La spondylosis cervical can manifest as one of three clinical forms following, or the combination of several of them:

1- Axial neck pain

It's a pain that travels along the cervical spine and adjacent muscles. It can radiate to the upper back, the shoulder or the back of the head. This pain is often accompanied by stiffness at the neck.

2- Cervical radiculopathy (compression of a nerve root)

Spinal nerves are vulnerable to stretching or compression. Thus, when they are compressed, in particular during cervical spondylosis, the result is symptoms that are grouped under the name « radiculopathy ».

Among the symptoms of this radiculopathy cervical, we can cite:

  • Root pain: pain along the path of the nerve whose root is compressed (neck, shoulder, upper limb, etc.). People who suffer from it often tend to tilt their head to the side opposite the seat of pain. Moving the head, coughing or sneezing aggravates the intensity of the pain.
  • Paresthesias (tingling).
  • A loss of sensitivity at the level of the relevant dermatome (cutaneous area innervated by the compressed spinal root).
  • muscle weakness at the level of the myotome concerned (muscles innervated by the compressed spinal root).
  • A decrease or loss of reflexes muscles innervated by the compressed nerve root.

3- Cervical myelopathy (dysfunction of the spinal cord)

The cervical part of the spinal cord is thicker than the thoracic and lumbar regions. It takes up more space in the spinal canal. However, cervical spondylosis causes a narrowing of this canal, this is called "stenosis". This results in compression of the spinal cord and, when the latter is damaged, a cervical myelopathy.

Here are the symptoms that appear when there is a myelopathy cervical:

  • Weakness muscular at upper limb level.
  • Decreased dexterity of the hand (difficulty performing simple gestures such as buttoning his shirt or writing).
  • Decreased grip strength (the person may drop objects from their hand or be unable to pick up heavy objects).
  • Electric shock-like pain ou tingling when bending the neck forward.
  • Gait impairment: it is one of the first symptoms to appear during cervical spondylosis. Walking becomes unsteady and the patient spreads his legs to maintain his balance. At an advanced stage, the use of a cane or a walker may be necessary.
  • Urinary symptoms such incontinence can be seen in cervical spondylosis evolving for a long time.

How is the diagnosis of cervical spondylosis made?

The diagnosis of cervical spondylosis is largely based on the interrogation of the doctor and review clinical (search for symptoms by questioning the patient, then physical examination to objectify the clinical signs characteristic of this pathology).

Le the land is also very important for making the diagnosis: age generally over 60, profession exposing the neck to particular stress (fashion designer, watchmaker, etc.), genetic predisposition to osteoarthritis (first-degree relatives suffering from cervical osteoarthritis)…

Personalized medical imaging exams may be requested by the doctor to confirm his diagnosis or guide his treatment:

  • La cervical x-ray.
  • Le CT scan (study of the bones in more detail).
  • THECervical MRI (study of soft tissues: nerves and nerve roots especially).
  • La myelography (x-ray of the spinal cord after injection of a contrast product).

Cervical Spondylosis: Treatment and Management

Support for the spondylosis cervical depends on the degree of severity of the compression, and therefore on the symptoms. Its objective is to relieve pain and reduce the intensity of symptoms in order to allow the patient a normal socio-professional life.

It also targets the prevention of permanent damage nervous structures (spinal cord and nerves).

Medical treatment

The medications prescribed are generally intended to relieve root pain :

  • Over-the-counter painkillers (paracetamol, etc.)
  • Nonsteroidal anti-inflammatory drugs.
  • Steroidal anti-inflammatories (corticosteroids).
  • Muscle relaxants (muscle relaxants).
  • Antiepileptics and some antidepressants.

Surgical treatment

In severe forms, i.e. the existence of significant compression of the spinal cord (with major symptoms such as muscle weakness or urinary incontinence), intervention surgical may be needed:

Lifestyle and tips

It is possible to live with cervical spondylosis in the normal way. It just takes one daily regular with a doctor, therapeutic compliance (taking your treatments diligently) and adopting a healthy lifestyle :

  • Exercise regularly (a physiotherapist or physiotherapist can guide you on the procedure to follow).
  • Have a healthy and balanced diet.
  • Get enough good quality sleep.
  • Reduce stress as much as possible (relaxation methods, sport, regular pleasant activities, etc.).
  • Applying ice or heat to the neck for pain.
  • Wearing a soft neck brace occasionally to support the weight of the head and relieve the neck, following the recommendations of a health professional.

References

[1] AI Binder, “Cervical spondylosis and neck pain”, bmj, flight. 334, no 7592, p. 527-531, 2007.

[2] F. Lees and JA Turner, “Natural history and prognosis of cervical spondylosis”, Br.Med.J., flight. 2, no 5373, p. 1607, 1963.

[3] S. Singh, D. Kumar, and S. Kumar, “Risk factors in cervical spondylosis”, J. Clin. Orthop. Trauma, flight. 5, no 4, p. 221-226, 2014.

[4] LA Ferrara, “The biomechanics of cervical spondylosis”, Adv. Orthop., flight. 2012, 2012.

[5] WF Lestini and SW Wiesel, “The pathogenesis of cervical spondylosis. », Wink. Orthop., No 239, p. 69-93, 1989.

[6] “Cervical spondylosis and cervicarthrotic myelopathy – Neurological disorders”, MSD Manual Professional Edition. https://www.msdmanuals.com/en/professional/neurological-disorders/spinal-cord-disorders/cervical-spondylosis-and-cervicarthrosic-myelopathy (accessed April 9, 2022).

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