Spine: Spondylosis

Question 1

Define cervical spondylosis

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

Explain the aetiology/risk factors of cervical spondylosis

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

Summarise the epidemiology of cervical spondylosis

Answer 3

Mean age at diagnosis = 48 yrs

More common in MALES

Question 4

Recognise the presenting symptoms of cervical spondylosis

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

Recognise the signs of cervical spondylosis on physical examination

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

Question 6

Identify appropriate investigations for cervical spondylosis

Answer 6

Spinal X-Ray (lateral)