All You Need To Know About Cervical Spondylosis (Arthritis of the Neck)
Although neck pain can be caused by several factors, it is usually related to ageing. Just like in the other parts of the body, the discs and joints in the neck (cervical spine) gradually degenerate as we age. Cervical spondylosis, commonly referred to as arthritis of the neck, is the medical term for these age-related, degenerative changes that take place over time.
Cervical spondylosis is a highly common condition, affecting over 85 per cent of people over the age of 60. Most of the time, it causes pain and stiffness in the neck. However, there are a number of people who do not experience any noticeable symptoms. Usually, conservative treatment such as physical therapy and medication is effective in treating cervical spondylosis.
Which part of the body does it concern?
The spine is formed by 24 bones, known as vertebrae, that are stacked above one another. These bones connect together to form a canal that protects the spinal cord.
The cervical spine is made up of the seven small vertebrae that begin at the base of the skull and form the neck.
Other parts of the spine
Spinal cord and nerves
These are like electrical cables, travelling through the spinal canal and acting as messengers between the brain and muscles. Nerve roots branch out from the spinal cord through openings in the vertebrae known as foramen.
There are flexible intervertebral discs in between the vertebrae. These discs function as shock absorbers when walking or running. Flat and round, they have a thickness of around 0.5 inches. Intervertebral discs are formed by two parts, the annulus fibrosus and nucleus pulposus. The annulus fibrosus is the tough, flexible outer ring of the disc. The nucleus pulposus, on the other hand, is the soft, jelly-like centre of the disc.
What causes cervical spondylosis?
Cervical spondylosis stems from degenerative changes that take place in the spine as one ages. These changes happen in everyone and are normal. As a matter of fact, almost 50 per cent of all middle-aged people and older have worn disks but do not experience any painful symptoms.
Disc degeneration and bone spurs
The discs in the spine decrease in height and start to bulge as they age. Furthermore, they lose water content, start to dry out and become weakened. As a result, there is settling or collapse of the disc spaces and a loss of disc space height.
As the pressure on the facet joints increases, they start to degenerate and develop arthritis. This is similar to what may happen in the hip or knee joint. The smooth, slippery articular cartilage that protects and covers the joints can wear away.
This can result in the bones rubbing against each other if the cartilage is worn away completely. To account for this loss of cartilage, the body may react by developing new bone in the facey joints to support the vertebrae. This bone overgrowth is known as bone spurs. As time passes, these bone spurs may narrow the gap for the spinal cord and nerves to pass through (stenosis).
What are the risk factors for cervical spondylosis?
Age is the main risk factor for cervical spondylosis. Cervical spondylosis is largely common in people who are middle-aged and older.
There are other factors that can increase one’s risk of cervical spondylosis and neck pain, such as:
- Previous trauma or injury to the neck
- Anxiety or depression
- Smoking—this is clearly linked to increased neck pain
- Occupation—jobs with a lot of overhead work and repetitive neck motion
- Genetics—a family history of cervical spondylosis and neck pain
What are the symptoms of cervical spondylosis?
For the majority of patients with cervical spondylosis, no symptoms are experienced. However, if symptoms do occur, they usually include neck stiffness and pain. This pain may range from mild to severe intensity. It can be worsened by looking up or down for prolonged periods of time. It can also feel more intense during activities where the neck is held in place for an extended period of time, such as reading a book or driving. This pain normally subsides after lying down or resting.
Other symptoms of cervical spondylosis can include:
- Sensation or grinding or popping noise when turning the neck
- Muscle spasms in the neck and shoulders
- Tingling, weakness and numbness in the fingers, hands, arms, legs or feet
- Difficulty walking, lack of coordination and loss of balance
- Loss of bladder or bowel control
How is a doctor evaluation carried out?
First, the patient’s medical history and general health will be discussed. Next, a careful examination of the neck, shoulders, arms and legs may be conducted. The doctor will perform a number of tests to look for issues or changes in:
- Blood flow
- Touch sensation
- Strength—in your arms, hands, and fingers
- Flexibility—in your neck and arms
- Gait (the way you walk)
The doctor may also gently press on the patient’s neck and shoulders to feel for swollen glands or tender trigger points. Additionally, they may ask some questions to gain more understanding about any symptoms or injuries that may have happened to the neck. Such questions can include:
- When did the pain begin?
- When does it occur? Is it continuous or does it come and go?
- Do certain activities worsen the pain?
- Have you ever experienced pain before?
- Have you ever been treated for pain?
- Have you ever been involved in an accident or suffered an injury to the neck?
Diagnostic tests may be ordered to help confirm whether the patient has cervical spondylosis. Such tests can include:
X-rays are able to produce images of dense structures like bone. They are able to provide a view of the alignment of the bones along the neck. They can also reveal degenerative changes in the cervical spine like the presence of bone spurs or a loss of disc height.
Magnetic resonance imaging (MRI) scans
MRI scans are able to produce clearer images of the soft tissues in the body. These include muscles, discs, nerves and the spinal cord. An MRI scan is able to help determine whether the patient’s symptoms are a result of damage to the soft tissues, like a herniated or bulging disk.
Computed tomography (CT) scans
These produce more detail than plain X-rays and can produce a clearer view of the spinal canal and any bone spurs.
A myelogram is a unique kind of CT scan. In such procedures, a contrast dye is injected into the spinal canal to allow the spinal cord and nerve roots to appear more clearly.
Electromyography measures the electrical impulses of the muscles at rest and during contractions. Most of the time, EMG is done along with nerve conduction studies to determine if a spinal nerve is functioning as it should.
In certain cases, the doctor may order a blood test to see whether a rheumatoid factor, or any other antibody indicative of inflammatory arthritis, is present.
How is cervical spondylosis treated?
Most of the time, cervical spondylosis is treated nonsurgically. Nonsurgical treatment options can comprise of the following:
Normally, physical therapy is the first treatment option recommended. There are specific exercises that can help to relieve pain, as well as strengthen and stretch strained or weakened muscles. In certain cases, physical therapy may include posture therapy or the use of traction to stretch the joints and muscles of the neck gently. Physical therapy sessions are usually scheduled twice to thrice a week. Programs may vary in length, but they normally range from 6 to 8 weeks.
During the initial stages of treatment, the doctor may prescribe various medications to address the inflammation and pain.
- Acetaminophen: This is often used to relieve mild pain
- Nonsteroidal anti-inflammatory drugs (NSAIDs): These are often prescribed with acetaminophen. NSAIDs such as naproxen and ibuprofen are considered first-line medications for neck pain. They can relieve swelling and pain and may be prescribed for several weeks, depending on the specific symptoms. Other kinds of pain medication can be considered if the pain is not improving or if one has serious contraindications to NSAIDs.
- Muscle relaxants: Medications such as carisoprodol or cyclobenzaprine may be used to treat painful muscle spasms.
Soft cervical collar
A soft cervical collar is a padded ring that is wrapped around the neck and held in position using velcro. It may be prescribed to limit neck motion and allow the neck muscles to rest. However, long-term wear can weaken the neck muscles. As such, it should only be worn for a short amount of time.
Heat, ice, and other modalities
The doctor may recommend cautious use of massage, heat, ice and other local therapies to help in relieving symptoms.
Steroid injections have provided numerous patients with short-term relief of their symptoms. The most common methods involving steroid-pain injections are as such:
- Cervical epidural block. Anaesthetic and steroid medication is injected into the gap beside the covering of the spinal cord, known as the epidural space. This method is normally used for neck or arm pain caused by a cervical disk herniation, also called radiculopathy or a pinched nerve.
- Cervical facet joint block. Anaesthetic and steroid medication is injected into the capsule of the facet joint. These facet joints are found in the back of the neck and provide movement and stability. They may develop arthritic changes that can cause neck pain.
- Medial branch block and radiofrequency ablation. This method is used for certain cases of chronic neck pain. It is able to both diagnose and treat a painful joint. During the diagnosis process, a local anaesthetic is used to block the nerve that supplies the facet joint. If the pain is relieved, that means the source of neck pain may have been determined. The next step then may be to block the pain more permanently by damaging the nerves that supply the joint. A burning technique is used for this, a procedure known as radiofrequency ablation.
Even though steroid-based injections are less invasive as compared to surgery, they are only prescribed following a full doctor evaluation. The benefits and risks of steroid-based injections for the specific condition will also be discussed between the doctor and patient.
Normally, surgery is not recommended for cervical spondylosis and neck pain. This is unless:
- The spinal is being compressed (cervical spondylotic myelopathy)
- A spinal nerve is being pinched by a herniated bone or disc (cervical radiculopathy)
On top of that, surgery has proven to be a better option for those with progressive neurologic symptoms like arm weakness, numbness or falling.
Furthermore, surgery may be recommended if one’s severe pain is unable to be relieved by nonsurgical treatment. However, not all patients with severe neck pain are suitable candidates for surgery. This can be because of the widespread nature of their arthritis, other medical issues or other causes of pain like fibromyalgia.