[9] Cervical Spondylosis Flashcards
What is cervical spondylosis?
A non-specific degenerative process resulting in stenosis of the spinal canal, and /or root canals of the cervical vertebrae
What are the most commonly affected levels in cervical spondylosis?
- C5/6
- C6/7
How common is cervical spondylosis?
Very
How does cervical spondylosis progress with age?
It gets worse
What percentage of over 60’s are affected by cervical spondylosis?
> 85%
What factors are involved in the development of cervical spondylosis
- Dehydration of discs
- Osteophytes
- Hypertrophy of lamina, articular facets, ligamentum flavum, and posterior longitudinal ligament
- Congenitally narrowed canal
Why does dehydration of the intervertebral discs contribute to cervical spondylosis?
It allows for more bone-to-bone contact between the vertebrae
What causes spondylosis?
Years of constant abnormal pressure placed on the vertebrae and their discs
What can cause the factors causing cervical spondylosis?
- Joint subluxation
- Stress induced by sports
- Acute and/or repetitive trauma
- Poor posture
What does the body do as a result of abnormal pressure on the cervical vertebrae?
Produce new bone to compensate for the change in weight distribution
What are the risk factors for cervical spondylosis?
- Age
- Occupation
- Previous neck injuries
- Genetic factors
- Smoking
What symptoms do most people with cervical spondylosis experience?
None
What symptoms present in cervical spondylosis if any?
- Pain
- Stiffness
Where does pain occur in cervical spondylosis?
- Cervical pain
- Referred pain to occiput, between shoulder blades and upper limbs
- Retro-orbital or temporal pain*
*When does retro-orbital or temporal pain occur in cervical spondylosis?
When there is involvement of C1 and C2
What signs can be seen on examination in cervical spondylosis?
- Limited range of movement
- Minor neurological changes
- Poorly localised tenderness
What neck movements can be limited by cervical spondylosis?
- Forward flexion
- Backward extension
- Lateral flexion
- Rotation
What is an example of a minor neurological problem that can be seen in cervical spondylosis?
Inverted supinator jerks
What can cervical spondylosis sometimes do to the spinal canal?
Cause narrowing
What can happen as a result of the narrowing of the spinal canal sometimes seen in cervical spondylosis?
Pinching of the spinal cord or nerve roots
What is it called when there is pinching of the nerve roots or spinal cord due to spinal canal narrowing?
Radiculopathy
When should radiculopathy be suspected in cervical spondylosis?
When there is unilateral neck, shoulder or arm pain approximating to a dermatome
What accompanying symptoms can be seen in radiculopathy?
- Changes in sensation
- Weakness in related muscles
- Diminished reflexes at appropriate level
What investigations may be used to assess cervical spondylosis?
- X-ray of cervical spine
- MRI
What might an x-ray of the cervical spine show in cervical spondylosis?
Narrowing of the disc spaces with encroachment of the intervertebral foraminae
Is narrowing of the disc spaces with encroachment of the intervertebral foraminae on cervical x-ray diagnostic of cervical spondylosis?
No, they can be common in middle aged patients
When is an MRI necessary in cervical spondylosis?
In a patient with neurological abnormality especially, progressive myelopathy, radiculopathy or intractable pain
What are some differentials of cervical spondylosis?
- Non-specific neck pain lesions
- Malignancy
- Infections
- Mechanical lesions
- Fibromyalgia
- Psychogenic neck pain
- Inflammatory disease e.g. RA
- Metabolic disease
What other non-specific neck pain lesions may present like cervical spondylosis?
- Acute neck strain
- Postural neck ache
- Whiplash
What malignancies are differentials for cervical spondylosis?
- Primary tumour of bone
- Metastases
- Myeloma
What infections are differentials for cervical spondylosis?
- Osteomyelitis
- Tuberculosis
What mechanical lesions may present like cervical spondylosis?
Disc prolapse
What metabolic diseases are differentials for cervical spondylosis?
- Paget’s disease of bone
- Osteoporosis
What red flag symptoms suggest malignancy or infection rather than cervical spondylosis?
- Fever or chills
- Weight loss
- Relentless nocturnal pain
- History of cancer
- Immunosuppression
What symptoms are red flags for myelopathy instead of cervical spondylosis?
- Insidious progression
- Gait disturbance
- Loss of sexual, bladder or bowel function
- Lhermitte’s sign
What is Lhermitte’s sign?
Neck flexion causes electric shock type sensation radiating down the spine
How should symptoms of cervical spondylosis be managed in the first 4 weeks?
With reassurance, advice to keep active and avoid use of a cervical collar.
What concerns may patients with cervical spondylosis have that should be addressed?
Fear of chronic disability
What treatment should be considered for prolonged (4-12 weeks) symptoms of cervical spondylosis?
Referral to physiotherapy for ‘mechanical’ treatment
What treatment should be considered for patients with chronic (>12 weeks) symptoms of cervical spondylosis?
- Referral to pain clinic
- Referral for surgery
What mechanical interventions can be performed by physiotherapists for cervical spondylosis?
Manipulation of the neck
What are the risks of mechanical intervention cervical spondylosis?
- Arterial dissection
- Myelopathy
- Vertebral disc extrusion
What pharmacological agents can be used to treat symptoms of cervical spondylosis?
- Analgesics
- Anti-inflammatory agents
- TCA’s
What are the indications for surgery in cervical spondylosis?
- Progressive neurological deficits
- Documented compression of cervical nerve root, spinal cord, or both
- Intractable pain
What does the surgical option for cervical spondylosis depend upon?
The precise pathology
How can cervical spondylosis surgery be classified?
- Anterior approach
- Posterior approach
When is an anterior approach to cervical spondylosis surgery indicated?
When the pathology extends in front of the root and cord
What anterior approach surgeries are available for cervical spondylosis?
- Simple discectomy
- Cloward’s procedure
- Decompression with plating or synthetic joint insertion
What is Cloward’s procedure?
Bone grafting into disc space
When is a posterior approach to cervical spondylosis surgery used?
When there is lateral cord narrowing
What are the posterior approach procedures available for cervical spondylosis?
- Foraminectomy
- Laminectomy +/- laminoplasty
What are the potential complications of cervical spondylosis surgery?
- Spinal cord injury
- Nerve root injury
- Oesophageal perforation
- Recurrent laryngeal nerve palsy (with anterior approach)
What are the potential complications of cervical spondylosis?
- Cervical myelopathy
- Paraplegia and tetraplegia
- Recurrent chest infection
- Pressure sores
