From the Guidelines
Straightening of the cervical spine, indicating myospasm, and mild spondyloarthritic changes are common findings that can contribute to pain, stiffness, and reduced range of motion in the neck, and treatment should focus on relieving symptoms and improving quality of life. The straightening of the cervical spine often indicates muscle spasm (myospasm) in the neck, which can occur due to injury, poor posture, or stress, as noted in studies on cervical neck pain and radiculopathy 1. This straightening represents a loss of the normal lordotic curve that should be present in the neck. Mild spondyloarthritic changes refer to early degenerative processes in the spine's joints, including small bone spurs (osteophytes), mild joint space narrowing, and minor calcification of ligaments. These changes are common with aging and represent wear and tear on the spine, as discussed in the context of ankylosing spondylitis and nonradiographic axial spondyloarthritis 2.
Key Considerations
- The presence of red flag symptoms such as trauma, malignancy, or systemic diseases should prompt further investigation, including imaging studies like MRI or CT scans, as recommended by guidelines for chronic back pain and suspected sacroiliitis-spondyloarthropathy 3.
- In the absence of red flag symptoms, initial evaluation may not require imaging, and treatment can focus on conservative measures such as physical therapy, anti-inflammatory medications, and posture improvement exercises, as suggested by studies on cervical radiculopathy 1.
- The goals of treatment should include reducing symptoms, maintaining spinal flexibility and normal posture, reducing functional limitations, and decreasing disease complications, as outlined in recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis 2.
Treatment Approach
- Physical therapy to restore proper alignment and muscle balance is a crucial component of treatment, aiming to improve mobility and reduce pain.
- Anti-inflammatory medications can help manage pain and inflammation, while posture improvement exercises can help prevent further degenerative changes.
- Heat therapy and gentle stretching may also be beneficial in relieving muscle spasm and improving mobility in the affected area, as part of a comprehensive treatment plan that prioritizes quality of life and functional outcomes.
From the Research
Significance of Straightening of the Cervical Spine
- The straightening of the cervical spine is sometimes attributed to muscle spasm, but a study 4 found that the prevalence of 'straight' cervical spines was similar in patients with acute and chronic neck pain, and also common in a normal population, suggesting that it may not be a reliable indicator of muscle spasm.
- Spondyloarthritic changes in the cervical spine can be associated with chronic neck pain and degenerative changes in the spine 5.
- Cervical spondylotic myelopathy (CSM) is a neurologic condition that can develop insidiously over time as degenerative changes of the spine result in compression of the cord and nearby structures 6, 7, 8.
- The hallmark symptoms of CSM include decreased hand dexterity and gait instability as well as sensory and motor dysfunction 6, 8.
Indications and Treatment
- Magnetic resonance imaging is the imaging modality of choice in patients with suspected CSM, but computed tomography myelography may be used in patients with contraindications 6.
- Patients with mild CSM may be treated surgically or nonoperatively, whereas those with moderate-severe disease are treated operatively 6, 7.
- The goal of surgery is to decompress the cord with expansion of the spinal canal, while restoring cervical lordosis, and stabilizing when the risk of cervical kyphosis is high 7.
- Conservative therapy modalities for spondylarthrosis of the cervical spine include physical therapy, subcutaneous application of local anesthetics, muscle, nerve and facet joint injections in addition to adequate analgesic and muscle relaxant therapy 5.