From the Guidelines
Cervical spondylitis should be evaluated using MRI of the spine to assess the spinal cord and surrounding structures, as it provides superior soft-tissue resolution and multiplanar capability. This approach is supported by the American College of Radiology, as stated in the 2021 update of the ACR Appropriateness Criteria for myelopathy 1. The use of MRI allows for the identification of intramedullary cord signal changes, which are prognostic factors for neurosurgical outcome in patients with spondylotic myelopathy 1.
When evaluating cervical spondylitis, it is essential to consider the potential for spinal cord ischemia, inflammatory, or infectious etiologies, and demyelinating diseases such as multiple sclerosis (MS) or neuromyelitis optica (NMO) 1. In these cases, MRI without and with intravenous (IV) contrast can provide valuable information, and diffusion-weighted imaging can show signal alteration in the spinal cord earlier than T2-weighted images 1.
Key considerations for managing cervical spondylitis include:
- Using MRI to evaluate the spinal cord and surrounding structures
- Considering potential etiologies such as spinal cord ischemia, inflammatory or infectious diseases, and demyelinating conditions
- Utilizing diffusion-weighted imaging to detect early signal changes in the spinal cord
- Including IV contrast in MRI evaluations when suspecting inflammatory or infectious etiologies, or demyelinating diseases
- Consulting a healthcare provider for severe or persistent symptoms, as prescription medications, steroid injections, or surgical intervention may be necessary.
From the Research
Definition and Causes of Cervical Spondylitis
- Cervical spondylosis is a common and disabling condition caused by degenerative disc disease, usually producing intermittent neck pain in middle-aged and elderly patients 2.
- It is a general and nonspecific term that encompasses a broad spectrum of afflictions, including cervical radiculopathy, cervical myelopathy, and axial joint pain 3.
Symptoms and Diagnosis
- The condition can cause neck pain, stiffness, and neurological symptoms such as radiculopathy or myelopathy 2, 3.
- Magnetic resonance imaging is the preferred initial diagnostic study, especially for patients with congenital spinal stenosis or neurologic symptoms 2.
- Consultation with a neurologist is advised to rule out other neurologic diseases 2.
Treatment Options
- Nonoperative modalities, including physiotherapy, analgesia, and selective nerve root injections, are recommended as initial management 4.
- Surgery may be indicated for patients with moderate to severe myelopathy, those who have failed conservative treatment, or those with progressive neurologic deficits 2, 4.
- Physical therapy can be effective in improving the quality of life for patients with cervical spondylosis, especially those with underlying conditions such as rheumatoid arthritis 5.
Surgical Interventions
- Surgical procedures may be done through the anterior or posterior cervical spine, with results showing long-term improvement in 70% to 80% of patients 2.
- Anterior cervical approaches are generally preferred, although there are still indications for laminectomy 2.
- Early surgical stabilization may be necessary for patients with ankylosing spondylitis and traumatic fracture/dislocation of the spine 6.