What are the risk factors for cervical spine osteoarthritis (Degenerative Joint Disease)?

From the Guidelines

Cervical spine arthritis risk factors primarily include age greater than 65 years, as indicated by high-risk factors for cervical spine injury. When considering the development of cervical spine arthritis, several key factors come into play, including:

• Advancing age, with degenerative changes naturally occurring over time, and most people showing some radiographic evidence by age 60
• Previous neck injuries or trauma, such as those from falls, axial load to the head, or motor vehicle crashes, which can accelerate degenerative processes 1
• Dangerous mechanisms, including falls from heights, axial load to the head, or high-speed motor vehicle crashes, which increase the risk of cervical spine injury and subsequent arthritis 1
• Paresthesias in extremities, which can be a symptom of underlying cervical spine issues, including arthritis
• Genetic predisposition, with family history often indicating higher susceptibility to degenerative joint diseases
• Occupational factors, such as jobs requiring repetitive neck movements, heavy lifting, or prolonged poor posture, which contribute substantially to cervical arthritis development
• Obesity, which places additional mechanical stress on the spine, and smoking, which impairs blood flow and nutrient delivery to spinal discs
• Certain inflammatory conditions, like rheumatoid arthritis, which specifically target cervical joints
• Poor posture, particularly from extended computer use or smartphone usage, creates abnormal pressure on cervical vertebrae
• Metabolic disorders, including diabetes, which can accelerate degenerative joint processes through vascular and inflammatory mechanisms Understanding these risk factors, particularly the high-risk factors for cervical spine injury, helps identify individuals who may benefit from preventive measures such as ergonomic adjustments, posture improvement, weight management, and appropriate physical activity to maintain neck mobility and strength 1.

From the Research

Risk Factors for Cervical Spine Arthritis

• The cervical spine can frequently become involved in patients with rheumatologic disorders, such as rheumatoid arthritis (RA), due to the disease itself or age-associated degenerative processes 2.
• Patients with RA often have spinal instability, which can lead to neurological deficits if left untreated 2, 3.
• Risk factors for cervical spine involvement in RA include:
  • Female gender 4
  • Positive rheumatoid factor (RF) 4
  • Long-term corticosteroids treatment 4
  • Erosion in hands or feet 4
  • Younger age 4
  • Long RA duration 4
  • Markers of higher disease activity (ESR, CRP, and Disease Activity Score) 4
• Cervical spine involvement can be seen in up to 86% of patients with RA, and neurologic involvement in up to 58% 5.
• Myelopathy is rare but can portend a poor prognosis 5.
• The goal of treatment is to prevent permanent neurologic injury while avoiding potentially dangerous and unnecessary surgery 6.

Cervical Spine Manifestations in RA

• The cervical spine can present with atlantoaxial instability (AAI), cranial settling (CS), or subaxial subluxation (SAS) in patients with RA 3.
• Atlantoaxial instability is the most common form of cervical involvement and may occur either independently or concomitantly with cranial settling and subaxial instability 5.
• Surgery may be required for patients with RA who develop neurologic deficits, or for those with severe kyphosis or fracture repair 2, 3.

Treatment and Management

• Biologic agents can be effective in slowing the progression of skeletal abnormality and treating RA 2.
• Early surgical intervention is recommended for patients with RA who develop neurologic deficits, as conservative approaches have limited effectiveness in this group 2, 6.
• The primary goal of treatment is to prevent permanent neurologic injury while avoiding potentially dangerous and unnecessary surgery 6.