Spondylosis (Cervical Spondylosis)

spondylosis is a common, age-related condition that affects the joints and discs in your cervical spine, which is in your neck. It’s also known as cervical osteoarthritis or neck arthritis.

It develops from the wear and tear of cartilage and bones. While it’s largely the result of age, it can be caused by other factors as well.

According to the Cleveland Clinic, the condition is present in more than 90 percent of people aged 60 and older.

Some people who have it never experience symptoms. For others, it can cause chronic, severe pain and stiffness. However, many people who have it are able to conduct normal daily activities.

Facts

  • The word spondylosis comes from the Greek word for vertebrae.
  • Spondylosis refers to degenerative changes in the spine such as bone spurs and degenerating intervertebral discs between the vertebrae.
  • Spondylosis changes in the spine are frequently referred to as osteoarthritis. For example, the phrase "spondylosis of the lumbar spine" means degenerative changes such as osteoarthritis of the vertebral joints and degenerating intervertebral discs (degenerative disc disease) in the low back.
  • Spondylosis can occur in the cervical spine (neck), thoracic spine (upper and mid back), or lumbar spine (low back). Lumbar spondylosis and cervical spondylosis are the most common.
    • Thoracic spondylosis frequently does not cause symptoms.
    • Lumbosacral spondylosis is spondylosis that affects both the lumbar spine and the sacral spine (below the lumbar spine, in the midline between the buttocks).
  • Multilevel spondylosis means that these changes affect multiple vertebrae in the spine.
  • There are several medical terms that sound similar to and are often confused with spondylosis including the following:
    • Spondylitis is inflammation of one or more vertebrae, such as in ankylosing spondylitis, an inflammatory form of arthritis of the spine. This is a very different process than spondylosis because spondylosis is degenerative while spondylitis is inflammatory.
    • Spondylolysis is incomplete development and formation of the connecting part of the vertebra, the pars interarticularis. This defect predisposes to spondylolisthesis (see below) because of spinal instability.
    • Spondylolisthesis is forward or backward displacement of the body of one vertebrae in relation to an adjacent vertebra. For example, anterior spondylolisthesis of L4 on L5 means that the fourth lumbar vertebra has slipped forward on the fifth lumbar vertebra. As a result, the spine is not normally aligned. If the displaced vertebrae shift with movement of the spine, this is referred to as dynamic spondylolisthesis. Dynamic shifting of the vertebrae is visualized with X-rays of the spine performed with patients flexing (bending forward) and then extending (bending backward) their back.
    • Spondylosis deformans is growth of bone spurs (osteophytes) or bony bridges around a degenerating intervertebral disc in the spine.
    • Spinal stenosis is narrowing of the spinal canal. This narrowing of the spinal canal limits the amount of space for the spinal cord and nerves. Pressure on the spinal cord and nerves due to limited space can cause symptoms such as pain, numbness, and tingling.
    • Sciatica is pain shooting down the sciatic nerve as it runs from the low back down the buttock and the leg, either on one side or both sides. Sciatica often occurs when a herniated disc puts pressure on the sciatic nerve as it exits the spinal canal in the low back. Sciatica is a specific type of radiculopathy (compression or irritation of nerves as they leave the spinal column). Sciatica can be associated with spondylosis because the degenerative changes in the spine predispose to disc herniation and subsequent nerve compression.

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The bones and protective cartilage in your neck are prone to wear and tear that can lead to cervical spondylosis. Possible causes of the condition include:

Bone spurs

These overgrowths of bone are the result of the body trying to grow extra bone to make the spine stronger.

However, the extra bone can press on delicate areas of the spine, such as the spinal cord and nerves, resulting in pain.

Dehydrated spinal discs

Your spinal bones have discs between them, which are thick, pad like cushions that absorb the shock of lifting, twisting, and other activities. The gel-like material inside these discs can dry out over time. This causes your bones (spinal vertebrae) to rub together more, which can be painful.

This process can begin to happen in your 30s.

Herniated discs

Spinal discs can develop cracks, which allows leakage of the internal cushioning material. This material can press on the spinal cord and nerves, resulting in symptoms such as arm numbness as well as pain that radiates down an arm. Learn more about herniated discs.

Injury

If you’ve had an injury to your neck (during a fall or car accident, for example), this can accelerate the aging process.

Ligament stiffness

The tough cords that connect your spinal bones to each other can become even stiffer over time, which affects your neck movement and makes the neck feel tight.

Overuse

Some occupations or hobbies involve repetitive movements or heavy lifting (such as construction work). This can put extra pressure on the spine, resulting in early wear and tear.

The greatest risk factor for cervical spondylosis is agingCervical spondylosis often develops as a result of changes in your neck joints as you age. Disc herniation, dehydration, and bone spurs are all results of aging.

Factors other than aging can increase your risk of cervical spondylosis. These include:

  • neck injuries
  • work-related activities that put extra strain on your neck from heavy lifting
  • holding your neck in an uncomfortable position for prolonged periods of time or repeating the same neck movements throughout the day (repetitive stress)
  • genetic factors (family history of cervical spondylosis)
  • smoking
  • being overweight and inactive

Most people with cervical spondylosis don’t have significant symptoms. If symptoms do occur, they can range from mild to severe and may develop gradually or occur suddenly.

One common symptom is pain around the shoulder blade. Some complain of pain along the arm and in the fingers. The pain might increase when:

  • standing
  • sitting
  • sneezing
  • coughing
  • tilting your neck backward

Another common symptom is muscle weakness. Muscle weakness makes it hard to lift the arms or grasp objects firmly.

Other common signs include:

  • a stiff neck that becomes worse
  • headaches that mostly occur in the back of the head
  • tingling or numbness that mainly affects the shoulders and arms, although it can also occur in the legs

Symptoms that occur less frequently often include a loss of balance and a loss of bladder or bowel control. These symptoms warrant immediate medical attention.

The diagnosis of spondylosis is made using radiology tests such as plain film X-rays, MRI, or CT scans. X-rays can show bone spurs on vertebral bodies in the spine, thickening of facet joints (the joints that connect the vertebrae to each other), and narrowing of the intervertebral disc spaces. CT scans of the spine are able to visualize the spine in greater detail and can diagnose narrowing of the spinal canal (spinal stenosis) when present. MRI scans are expensive but show the greatest detail in the spine and are used to visualize the intervertebral discs, including the degree of disc herniation, if present. An MRI is also used to visualize the vertebrae, the facet joints, the nerves, and the ligaments in the spine and can reliably diagnose a pinched nerve.

Treatments for cervical spondylosis focus on providing pain relief, lowering the risk of permanent damage, and helping you lead a normal life.

Nonsurgical methods are usually very effective.

Physical therapy

Your doctor might send you to a physical therapist for treatment. Physical therapy helps you stretch your neck and shoulder muscles. This makes them stronger and ultimately helps to relieve pain.

You might also have neck traction. This involves using weights to increase the space between the cervical joints and relieve the pressure on the cervical discs and nerve roots.

Medications

Your doctor might prescribe certain medications if over-the-counter (OTC) drugs don’t work. These include:

  • muscle relaxants, such as cyclobenzaprine (Fexmid), to treat muscle spasms
  • narcotics, such as hydrocodone (Norco), for pain relief
  • anti-epileptic drugs, such as gabapentin (Neurontin), to relieve pain caused by nerve damage
  • steroid injections, such as prednisone, to reduce tissue inflammation and subsequently lessen pain
  • prescription nonsteroidal anti-inflammatory drugs (NSAIDs), such as diclofenac (Voltaren-XR), to reduce inflammation

Surgery

If your condition is severe and doesn’t respond to other forms of treatment, you might need surgery. This can involve removing bone spurs, parts of your neck bones, or herniated discs to give your spinal cord and nerves more room.

Surgery is rarely necessary for cervical spondylosis. However, a doctor may recommend it if the pain is severe and it’s affecting your ability to move your arms.

You cannot stop your body from growing older, but you can do a lot to improve the health of your spine. By following the tips listed below, you can enjoy the benefits of a healthy spine at any age.

  • Follow your doctor's treatment plan and continue your home exercise plan (if you were in physical therapy).
  • Sit and stand properly.
  • Learn to lift correctly.
  • Exercise regularly. (Aerobic exercise is especially good.)
  • Attain and maintain a healthy body weight.
  • Eat healthy (a well-balanced, low-fat diet rich in fruits and vegetables).
  • Stop smoking.
  • Avoid excessive use of alcohol.
  • Get plenty of rest.

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