What is Cervical Spondylosis
Cervical spondylosis is an age-related degenerative condition of the cervical spine involving progressive deterioration of the intervertebral discs, vertebral bodies, facet joints, and ligamentous structures that can lead to spinal canal narrowing and potential compression of the spinal cord and nerve roots. 1, 2
Pathophysiology and Anatomic Changes
Cervical spondylosis represents the most common progressive disorder affecting the aging cervical spine, resulting from a cascade of degenerative changes 3:
- Disc degeneration initiates the process, with loss of disc height and structural integrity 2, 3
- Osteophyte formation develops at the vertebral body margins and uncovertebral joints, which can encroach on neural structures 2, 3
- Ligamentous changes occur, including thickening and ossification of the posterior longitudinal ligament and ligamentum flavum 1
- Facet joint arthropathy contributes to both pain and canal stenosis 3
The degenerative process compromises the spinal canal diameter through both mechanical compression and developmental factors, particularly in patients with congenitally narrow canals 2, 4. This compression can produce direct neurological damage or ischemic changes leading to spinal cord dysfunction 3.
Epidemiology and Natural History
The prevalence and severity of cervical spondylosis increase dramatically with age 1:
- 53.9% of patients demonstrate disc degenerative changes in large population studies 1
- The condition affects most people if they live long enough, making it part of the normal aging process 2
- Cervical spondylotic myelopathy (CSM) represents the most common cause of myelopathy in adults 2
Clinical Presentations
Cervical spondylosis manifests in three distinct clinical patterns:
Axial Neck Pain
- Most common presentation, typically intermittent in middle-aged and elderly patients 4
- 30-50% of patients develop chronic symptoms lasting more than one year 1
- Nearly 50% may have residual or recurrent pain up to 1 year after initial presentation 5
Cervical Radiculopathy
- Annual incidence of approximately 83 per 100,000 persons 1
- Presents as neck and/or upper limb pain with varying degrees of sensory or motor deficits 1
- 75-90% of patients achieve symptomatic relief with conservative therapy 1, 6
Cervical Spondylotic Myelopathy (CSM)
- Most serious and disabling manifestation of the disease 4
- Patients present with signs and symptoms of cervical spinal cord dysfunction with or without cervical nerve root injury 2
- May or may not be accompanied by pain in the neck and/or upper limb 2
- Occurs particularly in patients with congenitally small cervical canals 2, 4
Prognostic Factors
Several factors predict worse outcomes 5:
- Female gender is associated with poorer prognosis 5
- Older age correlates with worse outcomes 5
- Coexisting psychosocial pathology predicts poor response to treatment 5
- Radicular symptoms indicate more severe disease 5
- Longer duration of symptoms before treatment correlates with worse outcomes 5
Diagnostic Approach
Initial Imaging
- Radiographs serve as the first imaging modality for chronic neck pain, though correlation between radiographic findings and clinical symptoms remains unclear 1, 5
- Spondylotic changes are commonly identified in patients >30 years of age and correlate poorly with the presence of neck pain 5
Advanced Imaging
- MRI is the most sensitive test for detecting soft tissue abnormalities, correctly predicting 88% of cervical radiculopathy lesions 1, 6, 2
- However, MRI has high rates of abnormalities in asymptomatic individuals, requiring correlation with clinical findings 1, 5
- CT offers superior depiction of cortical bone and is particularly useful for evaluating osteophytes, uncovertebral joints, and facet joints 1
Critical Pitfall
Do not rely solely on imaging findings for treatment decisions, as spondylotic changes correlate poorly with symptoms and are frequently present in asymptomatic individuals 5. Always correlate imaging with clinical presentation before making treatment recommendations.