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Spondylitis, Cervical

Definition :
Cervical spondylosis is a chronic degeneration of the bones (vertebrae) of the neck (cervical spine) and the cushions between the vertebrae (disks). Also known as cervical osteoarthritis, the condition usually appears in men and women older than 40 and progresses with age. Although cervical spondylosis affects both sexes equally, men usually develop it at an earlier age than women do.

The degeneration in cervical spondylosis most likely is a result of wear and tear on the neck bones as you age. The changes that accompany the degeneration, such as developing abnormal growths (bone spurs) on the spine, can lead to pressure on the spinal nerves and, sometimes, the spinal cord itself.

Mild cases of cervical spondylosis often require no treatment or may respond to conservative treatment, including wearing a neck brace and taking pain medication. More severe cases of cervical spondylosis, however, particularly those involving pressure on the spinal nerves or cord, may require treatment ranging from neck traction to stronger medications to surgery.

Causes :
As you age, the disks of your spine become drier and less elastic. Degeneration can cause some of the disks to bulge and, in some cases, cause the central cartilage of the disks to protrude through a crack in the ring that surrounds the disk (herniate). The surrounding ligaments become less flexible, and the vertebrae may develop bone spurs.

These degenerative changes may be a result of wear and tear throughout your life. An earlier injury to your neck may predispose you to this degeneration. By age 60,

most people will show signs of cervical spondylosis on X-ray, although they may not have signs or symptoms.

Risk Factor :
Aging and wear and tear on your spine are the major risk factors for cervical spondylosis.

When to seek medical advice :
Call your doctor if :

  • You have neck pain that doesn't respond to over-the-counter pain medications
  • The pain worsens
  • You develop numbness in your arms or legs
Symptoms :
Neck pain and stiffness that gets progressively worse may be an indication of cervical spondylosis. The pain may range from mild to severe and debilitating. The condition may last for several months before improving, or it may become chronic. Other signs and symptoms may include :
  • Neck pain that radiates to the shoulders and arms
  • Numbness or weakness in the arms, hands and fingers
  • Headaches that radiate to the back of the head
  • Loss of balance
  • Numbness or weakness in the legs, if the spinal cord is compressed
  • Loss of bladder or bowel control, if the spinal cord is compressed

Diagnosis:
Your doctor will take a history of your condition and conduct a physical exam. He or she may test the flexibility of your neck by having you bend your head to your shoulder and turn your head from side to side. Diagnostic tests may include the following :

  • Nerve functions test. Your doctor may check for neurological changes due to compression of the spine by testing your reflexes and seeing how the nerves and muscles in your arms and legs function. He or she may watch you walk to determine whether spinal compression is affecting your gait.
  • Neck or spinal X-ray. An X-ray may show abnormalities, such as bone spurs, that indicate cervical spondylosis.
  • Computerized tomography (CT) scan or magnetic resonance imaging (MRI). A CT scan of your spine uses X-ray technology, but produces a more detailed image than X-ray can. MRI uses a magnetic field and radio waves and can produce detailed, cross-sectional images of your spine. These tests may help your doctor determine the extent of damage to your cervical spine.
  • Myelogram. This test involves generating images using X-rays or CT scansafter dye is injected into the spinal canal. The dye makes areas of your spine more visible.

Complications :
Cervical spondylosis is the most common cause of spinal cord dysfunction in older adults. If the condition progresses and isn't treated, or if treatment isn't successful, the disabilities may become permanent. Complications may include :

  • Pressure on the spinal cord. Degenerative changes in the spine can lead to narrowing of the spinal canal that houses the cord (spinal stenosis), resulting in pressure on the cord anywhere along the spine. Cervical spondylosis can cause narrowing of the canal of the cervical spine, which can lead to numbness and weakness in your arms as well as your legs, even affecting your ability to walk. Pressure on the spinal cord also may cause loss of bowel or bladder control (cervical myelopathy).
  • Pressure on the spinal nerves (cervical radiculopathy). Spinal stenosis, bone spurs or herniated disks can put pressure on the roots of one or more nerves that branch off the spinal cord at the neck. The pressure irritates the nerve, which may cause pain, tingling, burning, weakness or numbness down your arms or in your hands.
Treatment:
Without treatment, the signs and symptoms of cervical spondylosis may decrease or stabilize, or they may worsen. The goal of treatment is to relieve pain and prevent permanent injury to the spinal cord and nerves.

Treatment of mild cases
Mild cases of cervical spondylosis may respond to :

  • Wearing a neck brace (cervical collar) during the day to help limit neck motion and reduce nerve irritation.
  • Taking nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil, Motrin, others) for pain relief.
  • Doing exercises prescribed by a physical therapist to strengthen neck muscles and stretch the neck and shoulders. Low-impact aerobic exercise, such as walking or water aerobics, also may help.

Treatment of more serious cases
For more severe cases, nonsurgical treatment may include :

  • Hospitalization with bed rest and traction on the neck for a week or two to completely immobilize the cervical spine and reduce the pressure on spinal nerves.
  • Taking muscle relaxants, such as methocarbamol (Robaxin) or cyclobenzaprine (Flexeril), particularly if neck muscle spasms occur, and taking narcotic medications to relieve severe pain.
  • Injecting corticosteroid medications into the joints between the vertebrae (facet joints). The injection combines corticosteroid medication with local anesthetic to reduce pain and inflammation.

Surgery
Your doctor may recommend surgery to relieve compression of spinal nerves or the spinal cord if you have severe pain that doesn't improve with more conservative treatment or if your neurological symptoms, such as weakness in your arms or legs, are getting worse. The surgical procedure will depend on your underlying condition, such as bone spurs or spinal stenosis. The most common surgical options include :

  • Frontal approach (anterior). Your surgeon makes an incision in the front of your neck and moves aside the windpipe (trachea) and swallowing tube (esophagus) to expose the cervical spine. Your surgeon can then remove a herniated disk or bone spurs, depending on the underlying problem. Sometimes, with disk removal, your surgeon will fill the gap with a graft of bone or other implant.

    With the anterior approach, your surgeon can relieve pressure on your spinal cord from bone or more than one disk by removing two disks and the bone between them (corpectomy). Then, to support your head and neck, your surgeon reconstructs the area with bone from your body or a bone bank or with an implant made of metal combined with bone.

  • Back approach (posterior). Your surgeon may opt to remove or rearrange bone from the back of your neck, especially if several portions of the channel that houses the cord have narrowed. Your surgeon makes an incision at the back of your neck and removes the back part of the bone over the spinal canal (laminectomy). Or your surgeon may cut the bones in several places and rearrange them to make more room for the spinal cord (laminoplasty).

    Laminoplasty may require more time in surgery, but it preserves stability of the cervical spine. Laminectomy may leave the neck unstable. In some cases, a surgeon may connect two or more vertebrae (fusion), which stabilizes the spine but causes stiffness and permanent loss of movement. Fusion may involve bone grafts and the use of wires, rods, screws or plates to hold the spine in place.

Risks of surgery
Risks of these procedures include infection, a tear in the membrane that covers the spinal cord at the site of the surgery, bleeding, a blood clot in a leg vein, and neurologicaldeterioration. In addition, the surgery may not eliminate all the problems associated with your condition.

Prevention:
You may not be able to prevent cervical spondylosis because it involves the aging process. However, you may be able to reduce your risk by :

  • Skipping high-impact activities, such as running and high-impact aerobics, if you have any neck pain
  • Doing exercises to maintain neck strength, flexibility and range of motion
  • Taking breaks when driving, watching TV or working on a computer to keep from holding your head in the same position for long periods
  • Practicing good posture, with your neck aligned over your shoulders
  • Protecting your neck from injury by using a seat belt when in a car and avoiding activities that strain your neck
 
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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