Neck and Back

Cervical Spondylosis (Arthritis of the Neck)

Anatomy

The spinal column is made up of small bones (vertebrae) stacked on top of one another, creating the natural curves of the back. Between the vertebrae are flat, round, rubbery pads (intervertebral disks) that act as shock absorbers and allow the back to flex or bend. Muscles and ligaments connecting the vertebrae allow motion while providing support and stability for the spine and upper body. Each vertebra has an opening (foramen) in the center and these line up to form the spinal canal. Protected by the vertebrae, the spinal cord and other nerve roots travel through the spinal canal. Nerves branch out from the spinal column through vertebral openings, carrying messages between the brain and muscles. Facet joints align at the back of the spinal column, linking the vertebrae together and allowing for rotation and movement. Like all joints, cartilage covers the surface where facet joints meet.

The spine contains three segments: lumbar, thoracic and cervical. The lumbar spine consists of five vertebrae located in the lower back; lumbar vertebrae are larger because they carry more of the body's weight. The thoracic spine consists of 12 vertebrae and begins at the upper chest, extending to the middle back and connecting to the rib cage. The cervical spine includes the neck and consists of seven small vertebrae, beginning at the base of the skull and ending at the upper chest. Disks in the lumbar spine are composed of a thick outer ring of cartilage (annulus) and an inner gel-like substance (nucleus). In the cervical spine, disks are similar but smaller in size. The cervical spine supports the weight of the head and connects it to the shoulders and body. It is less protected than the rest of the spine, making it more vulnerable to injury and disorders that produce pain and restricted motion.

Description

Cervical spondylosis is the degeneration of the joints in the neck. Like the rest of the body, the bones in the cervical spine, or neck, slowly degenerate as we age, frequently resulting in cervical spondylosis, or arthritis of the neck. Cervical spondylosis becomes increasingly more common as people age, with more than 85% of people over age 60 affected. Although it is a form of arthritis, cervical spondylosis rarely becomes a crippling or disabling type.

Symptoms

Pain from cervical spondylosis ranges from mild to severe and is sometimes worsened by looking up or down for long periods of time, as with driving a car or reading a book. Rest or lying down typically offers relief. Additional symptoms include: neck pain and stiffness (may worsen with activity); numbness and weakness in arms, hands, and fingers; difficulty walking, loss of balance, or weakness in hands or legs; muscle spasms in neck and shoulders; headaches; or grinding and popping sound/feeling in neck with movement.

Causes

In children and young adults, intervertebral disks have a high water content. As we age, they dry out, causing them to stiffen and weaken. The disks settle, or collapse, and lose height and begin to bulge. The space between disks grows smaller and the vertebrae move closer together. The facet joints experience increased pressure and also begin to degenerate and develop arthritis, similar to what occurs in a hip or knee joint. The cartilage that covers and protects these joints wears away. If it erodes completely, the result is bone rubbing against bone. The body may respond to this degeneration and lost cartilage by growing new bone to strengthen and support the vertebrae. Over time, this bone overgrowth (bone spurs) may narrow the foramen where the nerves pass through (stenosis), resulting in cervical radiculopathy (pinched nerve) or cervical spondylosis (arthritis of the neck).

Risk Factors

Factors that increase your risk for cervical spondylosis include: genetics (a family history of neck pain); smoking, which has been clearly linked to increased neck pain; an occupation that requires a great deal of neck motion or overhead work; depression, anxiety or certain other mental health issues; and injury or trauma, such as an auto accident or an on-the-job injury.

Diagnosis

Determining the source of your pain is essential to recommending appropriate treatment and rehabilitation. A comprehensive examination will include a complete history of the difficulties you are experiencing with your neck. Your physician may asked to discuss: any illnesses or injuries that have occurred to your neck; any accidents you have been involved in; when the pain began and if it has occurred before; how often and how long it hurts; what makes it feel better or worse; and whether or not you have been treated for neck pain previously. A thorough physical exam will include your neck, shoulders, arms, and possibly your legs and your physician may press on your neck and shoulders to feel for trigger (tender) points or swollen glands, and your strength, touch sensation, reflexes, blood flow, flexibility of your neck and arms as well as your walking may also be tested. Blood tests and additional imaging studies, such as X-rays, magnetic resonance images (MRI), computed tomography (CT), myelography, or electromyography (EMG) may be required to fully assess your condition and confirm your diagnosis. Your physician may also consult with other medical specialists.

Nonsurgical Treatment

Cervical spondylosis is most commonly treated with nonsurgical options.

• Physical therapy—Typically, the first treatment that is advised is strengthening and stretching weakened or strained muscles. Your physical therapist may also use cervical (neck) traction and posture therapy. Physical therapy programs vary, but are usually scheduled 2 to 3 times per week, for 6 to 8 weeks.
• Medications—During the first phase of treatment, several medications may be used together to address both pain and inflammation. Acetaminophen may be used to relieve mild pain. Nonsteroidal anti-inflammatories (NSAIDs) such as ibuprofen and naproxen are considered first-line medicines for neck pain, and are often prescribed for a number of weeks in combination with acetaminophen to address both pain and swelling. If you have serious contraindications to NSAIDs or your pain is not well-controlled, other types of pain medication can be considered, depending on your specific problem. Painful muscle spasms may be treated with muscle relaxants, such as cyclobenzaprine or carisoprodol.
• Soft collars—These limit neck motion and allow neck muscles to rest. Soft collars should be worn for short periods of time only, as long-term wear can weaken neck muscles.
• Ice, heat other modalities—Careful application of ice, heat, massage and other local therapies can help relieve symptoms.
• Steroid-based injections—Many patients find short-term pain relief from steroid injections. Although less invasive than surgery, steroid-based injections are prescribed only after a complete medical evaluation. There are several types of these procedures, discuss the risks and benefits with your physician.
  
  Cervical epidural block: Steroid and anesthetic medicine is injected into the space next to the covering of the spinal cord (epidural space). Typically used for neck and/or arm pain that may be due to a cervical disk herniation (radiculopathy or pinched nerve).
  
  Cervical facet joint block: Steroid and anesthetic medicine is injected into the capsule of the facet joint in the back of the neck.
• Medial branch block and radiofrequency ablation—Used in some cases of chronic neck pain, as well as in the diagnosis and treatment of a potentially painful joint. During the diagnosis portion of the procedure, the nerve that supplies the facet joint is blocked with a local anesthetic. If the pain is completely relieved, your physician will have identified the source of your neck pain. Next, your physician will block the pain more permanently by damaging the nerve with radiofrequency, a procedure called radiofrequency ablation.

Surgery

Surgery is not commonly used to treat patients with only cervical spondylosis and neck pain. Surgical options are reserved for patients who have severe pain that has not been relieved by other treatment. Unfortunately, some patients with severe pain are not candidates for surgery due to the widespread nature of their arthritis, additional medical problems, or other causes for their pain, such as fibromyalgia. Patients with progressive neurologic symptoms, such as weakness, numbness, or falling are more likely to be helped by surgery.

Complications

As with any surgery, there are some risks, and these vary from person to person. Complications are typically minor, treatable and unlikely to affect your final outcome. For most people, surgery can provide relief of symptoms and return to function with relatively low risk of complications. Overall, elderly patients have higher rates of complications from surgery, as do patients who are overweight, diabetics, smokers, or suffering from multiple medical problems. Among the general, potential risks associated with surgery are infection, bleeding and blood clots, and reactions to anesthesia. Be sure to discuss the potential risks and benefits with your surgeon prior to surgery.