Cervical Spondylitis

Question 1

Define

Answer 1

progressive degenerative process affecting the cervical vertebral bodies and intervertebral discs, and causing compression of the spinal cord and/or nerve roots

Question 2

Cause

Answer 2

Osteoarthritic degeneration of the vertebral bodies leads to the formation of osteophytes

These osteophytes protrude on to the foramina and spinal canal

• This leads to compression of:
• Nerve roots - radiculopathy
• Anterior spinal cord - myelopathy

Question 3

Epidemiology

Answer 3

Mean age at diagnosis = 48 yrs

More common in MALES

Question 4

Symptoms

Answer 4

• Neck pain/stiffness
• Arm pain (stabbing or dull ache)
• Paraesthesia
• Weakness
• Clumsiness in the hands
• Weak and stiff legs
• Gait disturbance
• Atypical chest pain
• Breast pain
• Pain in the face

Question 5

Signs

Answer 5

ARMS

• Atrophy of the forearm and hand muscles
• Segmental muscle weakness in a nerve root distribution (e.g. C5 –> shoulder abduction and elbow flexion weakness)
• Hyporeflexia
• Sensory loss (mainly pain and temperature)
• Pseudoathetosis (writhing finger movements when hands are outstretched, fingers spread and eyes closed)

LEGS - if cervical cord compression

• Increased tone
• Weakness
• Hyper-reflexia
• Extensor plantar response
• Reduced vibration and joint position sense
• Lhermitte’s Sign - neck flexion causes crepitus (grating sound) and/or paraesthesia down the spine

Segmental muscle weakness in a nerve root distribution

C5: Shoulder abduction and elbow flexion weaknesses C6: Elbow flexion and wrist extension weaknesses
C7: Elbow extension, wrist extension and finger extensionweaknesses

C8: Wrist flexion and finger flexion weaknesses

Question 6

Investigations

Answer 6

Spinal X-Ray (lateral)

• Can detect osteoarthritic change
• Rarely diagnostic if non-traumatic

MRI

• Allows assessment of root and cord compression
• Helps exclude spinal cord tumour and nerve root infiltration by granulomatous tissue

Needle Electromyography (EMG)