CERVICAL SPONDYLOSIS
Cervical spondylosis is considered a natural process of ageing with a 95% prevalence by age 65 years. Most people remain asymptomatic but can present with axial neck pain, as well as progress to cervical radiculopathy and/or cervical myelopathy.
Cervical spondylosis is the most common spine dysfunction in elderly people .The symptoms can depend on the stage of the pathologic process and the site of neural compression. Degenerative disease of the cervical spine, or cervical spondylosis, is an age-related process that affects many components of the cervical spinal column. The spectrum of cervical spondylosis ranges from axial neck pain to radiculopathy to cervical spondylotic myelopathy. Physical examination findings correlated with diagnostic imaging studies can aid in diagnostic evaluation. Almost all patients with symptomatic cervical degenerative disease without neurologic involvement can be managed nonoperatively.
ANATOMY
The cervical spine has a lordotic curve made up of the 37 joints, first 7 vertebrae and section of the spinal cord from the superior border of the 1st vertebrae to the inferior border of the 7th vertebrae. Divided to the Upper (C1-2) and Lower (C3-7) Cervical regions. Atlas has no vertebral body and large vertebral foramen, axis has odontoid process for articulation with the Atlas and C7 has the longest spinous process. The lower cervical spine is composed of the 3rd to the 7th vertebrae which are all very similar. Each vertebral body is quite small. Its height is greater posteriorly than anteriorly and it is concave on its upper aspect and convex on its lower. On its upper margin it is lipped by a raised edge of bone. There are 6 cervical discs, because there is no disc between the upper two joints. The first disc is between the axis (C2) and C3. From this level downwards to the C7–T1 joint they link together and separate the vertebral bodies.
CAUSES
- Intervertebral disc degenerative changes
- Age
- Ligamentous and segmental instability
- Neck trauma
- Genetic factors
- Smoking
- Bad ergonomics
- Overuse
SYMPTOMS
-Neck pain – Radiating pain to the shoulder and arm – Numbness in the finger — Tingling sensation on the upper limb – discomfort while sleeping -burning sensation on the hand
Cervical spondylosis presents in three symptomatic forms as:
Non-specific neck pain – pain localised to the spinal column.
Cervical radiculopathy – complaints in a dermatomal or myotomal distribution often occurring in the arms. May be numbness, pain or loss of function. Cervical myelopathy – a cluster of complaints and findings due to intrinsic damage to the spinal cord itself. Numbness, coordination and gait issues, grip weakness and bowel and bladder complaints with associated physical findings may be reported. Symptoms can depend on the stage of the pathological process and the site of neural compression. Diagnostic imaging may show spondylosis, but the patient may be asymptomatic and vice versa. Many people over 30 show similar abnormalities on plain radiographs of the cervical spine, so the boundary between normal ageing and disease is difficult to define
Pain is the most commonly reported symptom. McCormack et al (1996) reported that intermittent neck and shoulder pain is the most common syndrome seen in clinical practice. With cervical radiculopathy the pain most often occurs in the cervical region, the upper limb, shoulder, and/or interscapular region . In some cases the pain may be atypical and manifest as chest or breast pain, although it is most frequently present in the upper limbs and the neck. Chronic suboccipital headache could also be a clinical syndrome in patients with cervical spondylosis, which may radiate to the base of the neck and the vertex of the skull. Paraesthesia or muscle weakness, or a combination of these are often reported and indicate radiculopathy. Central cord syndrome may also be seen in relation to cervical spondylosis and in some cases dysphagia or airway dysfunction have been reported.
TREATMENT
The treatment approach should be in a stepwise fashion. Patients experiencing axial neck pain without neurologic symptoms will typically have a resolution of symptoms within days to weeks, without any intervention. If symptoms persist, conservative therapy should initiate, including NSAIDs and physical therapy.
PHYSIOTHERAPY— Goals: To educate patient on pathophysiology, progression and prognosis of the condition -To relief pain – To Improve cervical ROM and mobility –To improve stabilization and balance –To prevent muscle atrophy –To strengthen weak muscles To prevent musculoskeletal deformities — Postural education
Means: Patient education –Manual Therapy — Soft Tissue Massage — Thermotherapy –Electrical Muscle Stimulation –Transcutaneous Electrical Nerve Stimulation –Hydrotherapy –Proprioceptive neuromuscular facilitation (PNF) –Postural re-education — Assistive devices/Orthoses
MEDICAL–Analgesics and steroid could be given to relieve the symptoms. Patients with radiographic stenosis but no clinical signs should be advised regarding the potential of a hyperextension force to result in spinal cord injury with even minor trauma (such as a low-energy fall or rear impact motor vehicle collision)
SURGICAL— Surgery is highly indicated if symptoms fail to improve after 4-6 week of conservative management and progression of symptoms in spite of non surgical management. There is strong evidence showing that surgery within one year from onset of symptoms strongly improves prognosis in CSM(J. C. Furlan et al,2011).
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