Cervical Spondylosis

Dr M K Mam
Cervical Spondylosis also known as cervical osteoarthritis is a very common problem and its prevalence is increasing. It is a degenerative disorder i.e. a wear and tear of aging involving intervertebral discs- the cushions in between the bones of neck– cervical vertebrae, facet joints i.e. posterior joints of neck and adjacent soft tissues. It is common in the middle aged and elderly, however, its prevalence is increasing among the younger people.
Clinical features: The patients usually present with pain in the neck although lot many people with cervical spondylosis experience no noticeable symptoms. Pain is initially intermittent and later on it becomes continuous. It may be radiating down the upper limb when there is involvement of the nerve root. Pain may also radiate to the upper part of shoulders, in between the shoulder blades and back of head. Some of the patients may present with episodes of dizziness or giddiness. Movements of neck are decreased. Movements of neck especially upward movement of neck worsens the pain. Sneezing and coughing may also increase the pain. Patients may present with tingling sensation, numbness, weakness of muscles of hand or arm when there is involvement of nerve roots. Occasionally patients may also present with weakness of lower limbs- legs and feet, and loss of control on urination especially when there is cord compression. Usually the onset of pain is insidious, however we do have exacerbations of acute attacks which may be alternating with long periods of relative pain free spells. On examination, there is diffuse tenderness i.e. pain on pressure in back and sides of neck, muscles of neck and shoulder blade region. There is spasm of the neck muscles. The neck movements are limited and painful a detailed neurological examination of both upper and lower limbs helps in assessing neurological involvement if any.
Risk factors: Advancement of age is certainly a major risk factor for cervical spondylosis. People carrying heavy load on head are at a higher risk as there is lot of extra pressure on the neck. Any previous neck injury increases the risk of cervical spondylosis. Jobs that involve repetitive neck movements, bending or holding the neck in one position for long hours and poor posture increase the risk of cervical spondylosis. Genetic factors are also involved as some individuals in certain families may be more affected with cervical spondylosis than others. Again lack of physical activity and overweight are possible risk factors. Smoking may also be a risk factor as it has been linked to increased neck pain.
Treatment: Main purpose of treatment is to provide pain relief, reduce the risk of permanent damage and help the person to lead a normal life. Conservative treatment is the main stay of treatment and most of the patients respond to it. Analgesics- pain killers (NSAIDS) and muscle relaxants are given to take care of acute pain and stiffness. Local application of heat or cold packs and massage is useful. In acute painful stage, cervical collar is advised to restrict the neck movements, and provide some support and rest to neck. We need to remember that use of collar has to be for a very short period when there is acute pain. Many of our patients somehow continue using collar even after acute pain is over , this has to be discouraged as prolonged use of collar is harmful. We need to educate the people to strengthen the natural collar i.e. muscles of neck by exercises. Once acute painful stage is over we must start neck and shoulder exercises to take care of range of movements of neck and strengthening of neck muscles. As such, physiotherapy is an important part of treatment. Cervical traction is useful as it helps in reducing muscle spasm. Short wave diathermy and ultrasound massage can be used and helps in many of the patients. Patients should be advised to use only one pillow at night. Yoga has been found to be beneficial in treatment of pain and stiffness of the neck region and it may be used as supportive along with conventional medications. Yoga relaxes mind, decreases muscle tension, increases range of movements in the joints, and builds muscle strength. However, it is important to do it under the guidance of an experienced teacher of yoga.
Operative treatment is considered in a small percentage of patients when conservative treatment is not effective and patient has progressive neurological deficit because of pressure on nerve root or spinal cord. Anterior discectomy and fusion is a commonly done operation. It involves removal of affected disc, osteophytes that are pressing on roots or cord and then fusion of the adjacent vertebrae by putting a bone graft in between the vertebrae along with fixation with a plate. The operation is quite effective in relieving symptoms and any pressure on nerve roots or cord in properly selected patients of cervical spondylosis.
Prevention: Exercises that include range of movement and muscle strengthening ones are very essential for keeping the neck in good condition. It has to be emphasised that exercises have to be done daily. Doing the exercise when one is fit and fine will certainly help us in keeping fit for long time to come. Again we need to stress on maintaining a proper posture. We should avoid sitting in the same position for longer periods. We must change position very often, just get up, stretch the neck and arms, and walk around for a minute or two every hour or so when we have to sit for long periods. Our working / study table, computer screen or smart phone has to be at a height that is comfortable and we need to adjust it in such a way that we do not have to bend our head or back forward. We must reduce or avoid activities that may put an abnormal stress on the neck. Yoga is very beneficial as it relaxes mind, decreases muscle tension, increases range of movements in the joints, and builds muscle strength. It is always good to be physically fit and active, as the active people in general suffer less of the neck and back pain than the people who are not active. Staying active keeps body especially the muscles and joints in good shape so that stress can be well taken care of.
(The author is formerly, Vice Principal, Professor. & Head Orthopaedics, CMC, Ludhiana)