Cervical spondylosis

Question 1

What is cervical spondylosis?

Answer 1

Degeneration of the spine with age

Degeneration of the annulus fibrosus combined with osteophyte formation on the adjacent vertebra leads to narrowing of the spinal canal and intervertebral foramina.

Question 2

What is the presentation of cervical spondylosis?

Answer 2

• Neck stiffness (but common in anyone >50yrs old)
• Crepitus on moving neck
• Stabbing or dull arm pain (brachialgia)
Forearm/wrist pain.

* Limited, painful neck movement ± crepitus 
* Neck flexion may produce tingling down the spine (Lhermitte’s sign)

Question 3

what are symptoms of root compression?

Answer 3

Pain/‘electrical’ sensations in arms or fingers at the level of the compression, with numbness, dull reflexes, LMN weakness, and eventual wasting of muscles innervated by the affected root

Question 4

what are symptoms of cord compression?

Answer 4

• Progressive symptoms (e.g. ↑weak, clumsy hands; gait disturbance)
  
  • UMN leg signs (spastic weakness, ↑plantars). UMN signs below level of the affected root suggests cord compression.
  • LMN arm signs (wasting, hyporeflexia)
  • Incontinence, hesitancy, and urgency are late features.

Question 5

What are differentials of cervical spondylosis?

Answer 5

• MS
• Nerve root neurofibroma
• Subacute combined degeneration of the cord (↓b12)
Compression by bone or cord tumours.

Question 6

Investigations for cervical spondylosis?

Answer 6

MRI

Question 7

What is treatment for cervical spondylosis?

Answer 7

analgesia (WHO ladder)

Surgery: interlaminar cervical epidural injections
• Transforaminal injections
• Surgical decompression (via anterior approach, e.g. discectomy or posterior approach, e.g. laminectomy or laminoplasty)

Question 8

What are complications?

Answer 8

myelopathy