cervical spondylosis

Spondylosis: ‘a spinal condition resulting from degeneration of the intervertebral discs in the cervical, thoracic, or lumbar regions’.

Dunsker (1981) stated that ‘cervical spondylosis is a common condition that affects all people, but to varying degrees. It is often blamed for vague symptoms about the head or neck and is commonly misdiagnosed when it is responsible for symptoms in an extremity’

How much of a problem is spondylosis?

Spondylosis: Radiological evidence can be seen in asymptomatic adults and 25% of individuals aged under 40 have some degree of disc degeneration (Rao, 2007). Symptoms may appear in persons as young as 30 years but are most common in individuals aged 40-60 years (Galhom and Al-Shatoury, 2009).

The most common sites of spondylosis are: C4-T1, T2,3,4 & L2-S1 (Areas of maximum motion and curvature).

What are the common symptoms of cervical spondylosis?

Neck pain unilateral or bilateral, radiating between the shoulder blades. Occasionally occipital (base of the skull) pain. It can also cause radicular pain (arm pain).  Vague tingling / numbness  in the upper limbs is often noted. Disturbed sleep, Limited range of movement, stiffness. Pain is aggravated by movement, particularly extension:

What causes spondylosis?

There is a strong association between neck & shoulder injury with manual handling, trunk flexion or rotation, repetitive movement, working in awkward or static postures & working with the hands above the head (Mayer et al 2012). Spontaneous onset, or after postures involving sustained flexion or extension (Grant, 2002).

In young adulthood, the cervical discs start to fissure posteriorly, due to continued shearing effects.

By late thirties, there are obvious transverse posterior fissures running between the uncovertebral joints. 

Only the anterior annulus, longitudinal ligaments are intact, so stability is due to the zygopophyseal  (facet) joints, posterior musculature and ligaments (Taylor and Twomey,2002).

It affects men and women equally, but usually starts earlier in men (Galhom and Al-Shatoury, 2009)..

How do you diagnose spondylosis?

Diagnosis is based on clinical and radiological (x-ray) presentation.

Palpation to the facet joints in the neck is accurate to help diagnose neck injury to a probability of 82% (Cleland & Koppenhaver 2005).

So what can help?

Non-steroidal anti-inflammatories (NSAIDS), corticosteroids, muscle relaxants.

Non-operative management is the best option for those with no neural components like arm pain, pins and needles etc. (Rao, 2002).

An arm support together with an alternative mouse may prevent work-related musculoskeletal disorders of the neck & shoulder

Massage for mechanical neck pain was found to provide immediate effectiveness both in pain & tenderness 

Chronic neck pain: acupuncture: better pain relief immediately after treatment & in the short-term (Trinh et al 2010).

Studies suggests that certain joint mobilisation techniques are better than others: APs and PAs provide faster pain relief in patients with unilateral cervical spondylosis than rotations and transverse pressure (Egwu, 2008).

There are more mechanoreceptors in the cervical spine (neck) than in the lumbar spine (low back) so proprioceptive exercises are important.

What is my prognosis?

There is poor prognosis one year after the onset, if the pain was severe at the onset of the symptoms and if the patient also has lower back pain at the same time then this is an indication of poor recovery.

Lees and Turner, 1963 found that approximately 45% had a good resolution of symptoms but 55% had minor or moderate symptoms.

Gore et al, 1987 found 43% had complete resolution of their symptoms. 25% had mild residual pain and 32% had moderate to severe residual pain.