What is the explanation and treatment for spondylosis of the cervical spine?

Explaining Cervical Spondylosis to Your Patient

Cervical spondylosis is a degenerative condition of the cervical spine that affects most people as they age, causing various symptoms from neck pain to neurological deficits depending on severity and structures involved. 1, 2

What Is Cervical Spondylosis?

• Cervical spondylosis refers to degenerative changes affecting the intervertebral discs, vertebrae, facet joints, and ligamentous structures in the neck 1
• These changes are part of the normal aging process and affect most people if they live long enough 1
• The condition involves degeneration of intervertebral discs, osteophyte formation (bone spurs), hypertrophy of facet joints, and potential ligamentous instability 3

Pathophysiology

• Degenerative changes begin in the intervertebral discs, which lose water content and height with age 4
• This leads to increased stress on surrounding structures and formation of bone spurs (osteophytes) that can narrow the spinal canal and neural foramina 4
• When these changes compress neural structures, they can cause:
  • Radiculopathy (nerve root compression) - causing arm pain and neurological symptoms 5
  • Myelopathy (spinal cord compression) - causing dysfunction of the spinal cord 5
• Patients with congenitally narrow spinal canals are at higher risk for developing neurological symptoms 1

Clinical Presentation

• Neck pain that is typically intermittent and may radiate to the shoulders, arms, or between the shoulder blades 2
• Decreased range of motion in the neck 5
• Radicular symptoms may include:
  • Pain radiating down the arm in a specific nerve distribution 5
  • Numbness or tingling in the arms or hands 5
  • Weakness in specific muscle groups 5
• Myelopathic symptoms may include:
  • Difficulty with fine motor tasks (buttoning shirts, handwriting) 6
  • Unsteady gait or balance problems 6
  • Generalized weakness or stiffness in the legs 5
  • Bowel or bladder dysfunction in severe cases 6

Natural History

• The natural history of cervical spondylosis is variable 5
• Many patients experience long periods of stable symptoms or slow progression 5
• In mild cervical spondylotic myelopathy (CSM), approximately 70% of patients maintain their clinical status over 3 years with nonoperative treatment 5
• More severe cases of CSM tend to progress over time, with less likelihood of spontaneous improvement 5
• Younger patients and those with milder disability have better prognosis 5

Diagnosis

• Magnetic resonance imaging (MRI) is the preferred diagnostic study for evaluating cervical spondylosis with neurological symptoms 1
• X-rays can show degenerative changes but cannot directly visualize neural compression 6
• CT myelography may be used when MRI is contraindicated 6
• Electrophysiologic testing (EMG/nerve conduction studies) can help exclude alternative diagnoses 1

Treatment Options

Conservative Management

• For mild symptoms without significant neurological deficits:
  • Activity modification and avoiding positions that worsen symptoms 2
  • Neck immobilization with a cervical collar for short periods 2
  • Isometric neck strengthening exercises 2
  • Anti-inflammatory medications 5
• Conservative treatment is effective for many patients with neck pain and mild radiculopathy 2
• For mild CSM (modified Japanese Orthopaedic Association score >12), nonoperative therapy may be appropriate for the first 3 years 5

Surgical Management

• Surgery is generally indicated for:
  • Progressive neurological deficits 1
  • Severe or persistent pain unresponsive to conservative measures 2
  • Moderate to severe myelopathy 5
• Surgical approaches include:
  • Anterior approaches (ACDF - Anterior Cervical Discectomy and Fusion) - particularly effective for 1-3 level disease 7
  • Posterior approaches (laminoforaminotomy, laminectomy) - often used for multilevel disease 5
• Surgical outcomes:
  • Good to excellent outcomes in approximately 90% of patients with radiculopathy treated with ACDF 7
  • Success rates of 52-99% for posterior foraminotomy for radiculopathy 7
  • For CSM, surgical decompression improves neurologic function in many patients and prevents worsening in others 1

Important Considerations

• Early diagnosis and appropriate management are crucial to prevent long-term disability, especially in cases of myelopathy 6
• The effectiveness of conservative treatments is better established for radiculopathy than for myelopathy 1
• Surgical risks must be weighed against potential benefits and the natural history of the condition 1
• Patients with mild signs and symptoms can be monitored, while those with progressive and moderate to severe deficits should be considered for surgery 1