Arthritis - neck

Definition

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

Alternative Names

Causes

Cervical spondylosis results from chronic degeneration of the cervical spine including the cushions between the neck vertebrae (cervical disks) and joints between the bones of the cervical spine. There may be abnormal growths or "spurs" on the vertebrae (the bones of the spine).

These accumulated changes caused by degeneration can gradually compress one or more of the nerve roots. This can lead to increasing pain in the neck and arm, weakness, and changes in sensation. 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 prior) can predispose to spondylosis, but the major risk factor is aging. By age 60, 70% of women and 85% of men show changes consistent with cervical spondylosis on x-ray.

Symptoms

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

Exams and Tests

A pain in the neck that continues to get worse is a sign of cervical spondylosis. It may be the only symptom in many cases. Examination often shows limited ability to flex the head to the side (bend the head toward the shoulder) and limited ability to rotate the head.

Weakness or sensation losses indicate damage to specific nerve roots or to the spinal cord. Reflexes are often reduced.

• A spine or neck x-ray shows abnormalities that indicate cervical spondylosis.
• A CT scan or spine MRI confirms the diagnosis.
• A myelogram (x-ray or CT scan after injection of dye into the spinal column) may be recommended to clearly identify the extent of injury.
• An EMG may also be recommended.
• An x-ray of the lower (lumbar) spine may reveal degenerative changes in this region.

Treatment

The goal of treatment is relief of pain and prevention of permanent spinal cord and nerve root injury.

In mild cases, no treatment is required. Symptoms from cervical spondylosis usually stabilize or regress with simple, conservative therapy including a cervical collar (neck brace) to restrict motion and non-steroidal anti-inflammatory medications (NSAIDs). Cortisone injections to specific areas of irritation may also be helpful.

Rarely, intermittent neck traction may be recommended instead of, or in addition to, a cervical collar. This usually consists of a halter-like device placed on the head and neck and attached to pulleys and weights.

For severe cases, hospitalization with complete bedrest and traction for 1 or 2 weeks may be needed. 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 for significant loss of movement, sensation, or function.

Surgical procedures may involve removal of bone and disk tissue impinging on the nerves of the spinal cord and stabilization of the neck by fusing the cervical vertebrae.

Outlook (Prognosis)

Most patients with cervical spondylosis will have some chronic symptoms, but they respond to non-operative interventions and do not require surgery.

Possible Complications

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

When to Contact a Medical Professional

Apply home treatment like use of a cervical collar which can be purchased at pharmacies and over-the-counter pain medications, but call your health care provider if there are signs of complications or if the condition becomes worse.

Call your health care provider if cervical spondylosis has been diagnosed and symptoms worsen, or if new symptoms develop (such as loss of movement or sensation of an area of the body).

Prevention

Many cases are not preventable. Prevention of neck injury (such as proper equipment and techniques when playing sports) may reduce risk.