Cervical spondylosis

Overview

Cervical spondylosis is a general term for age-related wear and tear affecting the spinal disks in your neck. As the disks dehydrate and shrink, signs of osteoarthritis develop, including bony projections along the edges of bones (bone spurs).

Cervical spondylosis is very common and worsens with age. More than 85% of people older than age 60 are affected by cervical spondylosis.

For most people, cervical spondylosis causes no symptoms. When symptoms do occur, nonsurgical treatments often are effective.

Symptoms

Most people experience no symptoms. When symptoms do occur, they typically include pain and stiffness in the neck.

Sometimes, cervical spondylosis results in a narrowing of the spinal canal within the bones of the spine (the vertebrae). The spinal canal is the space inside the vertebrae that the spinal cord and the nerve roots pass through to reach the rest of the body. If the spinal cord or nerve roots become pinched, you might experience:

• Tingling, numbness and weakness in the arms, hands, legs or feet
• Lack of coordination and difficulty walking
• Loss of bladder or bowel control

When to see a doctor

Seek medical attention if you notice a sudden onset of numbness or weakness, or loss of bladder or bowel control.

Causes

As people age, the structures that make up the backbone and neck gradually develop wear and tear. These changes can include:

• Dehydrated disks. Disks act like cushions between the vertebrae of the spine. By the age of 40, most people's spinal disks begin drying out and shrinking. As the disks become smaller, there is more bone-on-bone contact between the vertebrae.
• Herniated disks. Cracks also appear on the exterior of the spinal disks. The soft interior of a disk can squeeze through these cracks. Sometimes, it presses on the spinal cord and nerve roots.
• Bone spurs. As the disks break down, the body may produce extra amounts of bone in a misguided effort to strengthen the spine. These bone spurs can sometimes pinch the spinal cord and nerve roots.
• Stiff ligaments. Ligaments are cords of tissue that connect bone to bone. Spinal ligaments can stiffen with age, making the neck less flexible.

Risk factors

Risk factors for cervical spondylosis include:

• Age. Cervical spondylosis occurs commonly as part of aging.
• Occupation. Jobs that involve repetitive neck motions, awkward positioning or a lot of overhead work put extra stress on the neck.
• Neck injuries. Previous neck injuries appear to increase the risk of cervical spondylosis.
• Genetic factors. Some individuals in certain families will experience more of these changes over time.
• Smoking. Smoking has been linked to increased neck pain.

Complications

If cervical spondylosis severely compresses your spinal cord or nerve roots, the damage can be permanent.

Diagnosis

Your health care provider will likely start with a physical exam that includes:

• Checking the range of motion in your neck
• Testing your reflexes and muscle strength to find out if there's pressure on your spinal nerves or spinal cord
• Watching you walk to see if spinal compression is affecting your gait

Imaging tests

Imaging tests can provide detailed information to guide diagnosis and treatment. Examples include:

• Neck X-ray. An X-ray can show changes in the spine, such as bone spurs, that indicate cervical spondylosis. Neck X-ray can also rule out rare and more serious causes for neck pain and stiffness, such as tumors, cancer, infections or fractures.
• MRI. Using radio waves and a strong magnetic field, MRI can produce detailed images that can help pinpoint areas where nerves might be pinched.
• Computed tomography (CT) myelography. In this type of CT scan, a dye is injected into the spinal canal to provide more-detailed imaging. This test makes it easier to see the details of the spinal cord, spinal canal and nerve roots.

Nerve function tests

You may need tests to determine if nerve signals are traveling properly to your muscles. Nerve function tests include:

• Electromyography. This test measures the electrical activity in your nerves as they transmit messages to your muscles when the muscles are contracting and at rest.
• Nerve conduction study. Electrodes are attached to the skin above the nerve to be studied. A small shock is passed through the nerve to measure the strength and speed of nerve signals.

Treatment

Treatment for cervical spondylosis depends on its severity. The goal of treatment is to relieve pain, help you maintain your usual activities as much as possible, and prevent permanent injury to the spinal cord and nerves.

Medications

If nonprescription pain relievers aren't enough, your health care provider might prescribe:

• Nonsteroidal anti-inflammatory drugs. NSAIDs, such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve), are commonly available without a prescription. You may need prescription-strength versions to relieve the pain and inflammation associated with cervical spondylosis.
• Corticosteroids. A short course of oral prednisone might help ease pain. If your pain is severe, steroid injections may be helpful.
• Muscle relaxants. Certain drugs, such as cyclobenzaprine (Amrix, Fexmid), can help relieve muscle spasms in the neck.
• Anti-seizure medications. Some epilepsy medications can dull the pain of damaged nerves.
• Antidepressants. Certain antidepressant medications can help ease neck pain from cervical spondylosis.

Therapy

A physical therapist can teach you exercises to help stretch and strengthen the muscles in your neck and shoulders. This can be one of the best treatments for the pain and stiffness. Some people with cervical spondylosis benefit from the use of traction, which can help provide more space within the spine if nerve roots are being pinched.

Surgery

If conservative treatment fails or if neurological symptoms — such as weakness in your arms or legs — worsen, you might need surgery to create more room for your spinal cord and nerve roots.

The surgery might involve removing a herniated disk, bone spurs or part of a vertebra. A segment of your neck may need to be fused with bone grafts and hardware.

Self care

Mild cervical spondylosis might respond to:

• Regular exercise. Maintaining activity will help speed recovery, even if you have to temporarily modify some of your exercises because of neck pain. People who walk daily are less likely to experience neck and low back pain.
• Pain relievers you can buy without a prescription. Ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve) or acetaminophen (Tylenol, others) is often enough to control the pain associated with cervical spondylosis.
• Heat or ice. Applying heat or ice to your neck can ease sore neck muscles.
• Soft neck brace. The brace allows your neck muscles to rest. However, a neck brace should be worn for only short periods of time because it can eventually weaken neck muscles and cause neck stiffness.

Alternative medicine

Chiropractic adjustments can help relieve neck pain and stiffness. The chiropractor may manipulate your spine or perform massage to relieve symptoms. The treatment is typically done after X-rays of the cervical spine have been completed.

Both massage therapy and acupuncture are being studied to treat neck pain. Some early results suggest that both may be helpful.

Preparing for your appointment

You might be referred to a physical therapist or a doctor specializing in spine disorders (orthopedist).

Here's some information to help you get ready for your appointment, and to know what to expect.

What you can do

• Write down your symptoms and when they began.
• Write down your key medical information, including other conditions.
• Write down key personal information, including any major changes or stressors in your life.
• Make a list of all your medications, vitamins or supplements.
• Find out if anyone in your family has had similar problems.
• Ask a family member or friend to accompany you, to help you remember what you learn during the appointment.
• Write down questions to ask during the appointment.

Questions to ask your doctor

• What's the most likely cause of my symptoms?
• What kinds of tests do I need?
• What treatments are available?
• I have other health conditions. How can I best manage them together?

In addition to asking questions you've prepared, don't hesitate to ask other questions that come up during your appointment.

What to expect from your doctor

Your health care provider is likely to ask you a number of questions. Being ready to answer them may make time to go over points you want to discuss in-depth. You might be asked:

• Where exactly does your neck hurt?
• Have you had previous episodes of similar pain that eventually went away?
• Have you experienced any changes in your bladder or bowel control?
• Have you experienced tingling or weakness in your arms, hands, legs or feet?
• Do you have difficulty walking?
• What self-care measures have you tried, and have any of them helped?
• What are your occupation, hobbies and recreational activities?
• Have you ever had whiplash or another neck injury?