Cervical spondylosis

Question 1

Describe the pathogenesis of cervical spondylosis?

Answer 1

• Degeneration of annulus fibrosis + osteophyte formation on adjacent vertebrae
• Narrowing of spinal canal
• As the neck flexes and extends, the cord is:
  
  • Dragged over bony spurs anteriorly
  • Idented by thickened ligamentum flavum posteriorly

Question 2

Presenting complaint of Cervical spondylosis?

Answer 2

• Neck stiffness
• Crepitus on moving neck
• Stabbing or dull arm pain (brachialgia)
• Forearm/wrist pain

Question 3

Describe Cervical spondylotic radiculopathy (CSR)?

Answer 3

• Arm pain following a single cervical nerve root distribution
• Mechanical compression/ chemical irritation
  
  • As nerve roots exit the spinal canal

Question 4

Describe Cervical spondylotic myelopathy (CSM)?

Answer 4

• Neuro deficit in the upper and lower extremities
• Degenerative changes in disc / facet joints

Question 5

Signs of Cervical sponylosis?

Answer 5

• Limited, painful neck movement +/- crepitus
• Neck flexion may produce tingling down spine (Lhermitte’s sign)

Question 6

Specific clinical signs of radiculopathy (root compression)?

Answer 6

• Pain/electrical sensations in arms or fingers at compression level
• Numbness, LMN weakness, wasting of muscles innervated by effected root

Question 7

Specific clinical signs of cord compression?

Answer 7

• Progressive symptoms
  
  • Increasingly weak, clumsy hands, gait changes
• UMN leg sign
  
  • Weakness
• LMN arm signs
  
  • Wasting, hyporeflexia

Question 8

Learn the clinical patterns of nerve root impingement

Answer 8

Question 9

Answer 9

Question 10

Describe the management of cervical spondylosis?

Answer 10

• Urgent MRI spine
• Use presence of red flags to inform referral
• Analgesia + gentle activity
• Cervical collars
• If no improvement in 6 weeks:
  
  • Refer to neurosurgery

Question 11

Describe the use of cervical collars in cervical spolylosis?

Answer 11

• May give respite during periods of increased pain
• Restrict mobility to may prolong symptoms

Question 12

Describe neurosurgical interventions for cervical spondylosis?

Answer 12

• Interlaminar cervical epidural injections
• Transforaminal injections
• Surgical approach:
  
  • Anterior approach: Discectomy
  • Posterior approach: Laminectomy or Laminoplasty