A Case Of Cervical Spondylosis

A 55 Year old Man is seen by his general physical with the complains of pain in his neck over the past 6 months. The pain has been gradually increasing but comes and goes with weeks without any pain. He mentions feeling stiffness in his neck early in the morning.
The pain sometimes spreads to his right shoulder and he feels tingling sensation in his right arm and hand. A Neck X ray was ordered and showed features of Cervical spondylosis:

Case Discussion

Cervical Spondylosis: Is an age related degeneration (wear and tear) of the bones (vertebrae) and discs in the neck. It is also known as  cervical osteoarthritis

According to certain studies more than 85% of people above the age of 60 years have cervical spondylosis but most of these people have no symptoms.

Etiology and Pathophysiology: As a person ages , the bones and cartilage that make up the backbone and neck gradually starts to wear and tear and develop certain degenerative changes. These changes can include:

• Vertebral discs which acts as cushions between the vertebrae of the spine begin to dry out and shrink by the age of 40 years, this leads to bone on bone contact between the vertebrae. 
• With increasing age the vertebral discs start to bulge (herniated disks) which sometimes may press on the spinal cord and nerve roots. 
• With gradual wear and tear , extra amount of bone is produced to strength the spine which leads to formation of bone spurs. These spurs can sometimes pinch the spinal cord and nerve roots. 
• Spinal ligaments can stiffen with age making the neck less flexible. 

Clinical Features: Most of the patients experience no symptoms and some have only mild pain. others may have serious symptoms if there is compression of the spinal cord or nerve roots.
Signs and symptoms may include:

• Pain in the neck : the pain may be mild to moderate in severity , and tends to come and go. It may spread to the shoulders or base of the skull or may sometimes even spread down to the arm and fingers of the hand due to irritation of the nerve which goes to the arm form the neck. 
• Some patients may experience neck stiffness particularly after a night's rest. 
• Headaches
• Cervical radiculopathy due to pressure on a nerve can cause feelings of pins and needles in parts of arm and hand.
• Problems with bladder function, severe quadriparesis or sensory loss below the neck can occur if pressure from the damaged vertebrae causes damage to the spinal cord. This condition is known as cervical myelopathy.  

Diagnosis: 

• Neck X ray can show abnormalities like bone spurs.
• Ct scan provides more detailed imaging of the neck bones and MRI can help pin point areas where the nerves are pinched. 

Management: Treatment depends upon the severity of pain and signs and symptoms and whether the nerves and compressed or not. 

1. Gentle neck exercise helps improve mobility and relieve pain.

2. Analgesics like paracetamol and NSAIDs are given to control mild to moderate pain. 

3. If the pain is severe corticosteroids like oral prednisone might help. 

4. Patients with chronic neck pain may get relief by using tricyclic antidepressant medications  or sometimes gabapentin is used. 

5. Surgery may be needed to decompress a spinal nerve root.