Cervical spondylosis

Question 1

What is myelopathy?

Answer 1

An injury to the spinal cord due to compression

Question 2

Describe the clinical spectrum of degeneration of the cervical cord

Answer 2

Asymptomatic

Progressive spastic quadriparesis

Question 3

Describe the pathogenesis of cervical spondylosis

Answer 3

Degeneration of the annulus fibrosus combined with osteophyte formation on the adjacent vertebra leading to narrowing of the spinal canal and intervertebral foramina
As the neck flexes and extends, the cord is dragged over these protruding bony spurs anteriorly and indented by a thickened ligamentum flavum posteriorly

Question 4

What is the annulus fibrosus

Answer 4

Tough coating of the intervertebral discs

Question 5

Describe the presenting complaint of cervical spondylosis

Answer 5

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

Question 6

What are the signs of cervical spondylosis

Answer 6

Limited painful neck movement
Crepitus
Lhermitte’s sign

Question 7

What is Lhermitte’s sign

Answer 7

Neck flexion produces tingling down the spine

Question 8

What is the word given to root compression

Answer 8

Radiculopathy

Question 9

Give the features of root compression

Answer 9

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

Question 10

Give the features of cord compression

Answer 10

UMN signs below level of affected root
Progressive symptoms
UMN leg signs - spastic weakness and upgoing plantars
LMN arm signs - wasting and fasciculations and hyporeflexia
Incontinence, hesitancy and urgency are late signs

Question 11

Describe Spurling’s manoeuvre

Answer 11

Passive head turning may worsen C6 radicular pain but not carpal tunnel

Question 12

What are the typical motor and sensory deficits of a C5 nerve root impingement

Answer 12

Weak deltoid and supraspinatus

Decreased supinator jerks and numb elbow

Question 13

Describe the pain pattern of a C5 nerve root impingement

Answer 13

Pain in neck/shoulder that radiates down front of arm to elbow

Question 14

What are the typical motor and sensory deficits of a C6 nerve root impingement

Answer 14

Weak biceps and Brachioradialis
Decreased biceps jerks
Numb thumb and index finger

Question 15

Describe the pain pattern of a C6 nerve root impingement

Answer 15

Pain in shoulder radiating down arm below elbow

Question 16

What are the typical motor and sensory deficits of a C7 nerve root impingement

Answer 16

Weak triceps and finger extension
Decreased triceps jerk
Numb middle finger

Question 17

Describe the pain pattern of a C7 nerve root impingement

Answer 17

Pain in upper arm and dorsal forearm

Question 18

What are the typical motor and sensory deficits of a C8 nerve root impingement

Answer 18

Weak finger flexors and small muscles of the hand

Numb 5th and ring finger

Question 19

Describe the pain pattern of a C8 nerve root impingement

Answer 19

Pain in upper arm and medial forearm

Question 20

Describe the management of cervical spondylosis

Answer 20

Guided by clinical presentation and red flags
Analgesia by WHO pain ladder and encourage gentle activity
If no better by 4-6 weeks or red flag symptoms then MRI and neurosurgical referral for interlaminar cervical epidural, transforaminal injections or surgical decompression by anterior approach (discectomy) or posterior approach (laminectomy or laminoplasty)