Spine: Spondylosis

Question 1

Definition

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

Aetiology

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:
o Nerve roots - radiculopathy
o Anterior spinal cord - myelopathy

Question 3

Epidemiology

Answer 3

• Mean age at diagnosis = 48 yrs

* More common in MALES

Question 4

Presenting 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 on physical examination (arms)

Answer 5

• ARMS

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

Question 6

Signs on physical examination (legs)

Answer 6

LEGS - if cervical cord compression

o Increased tone
o Weakness
o Hyper-reflexia
o Extensor plantar response
o Reduced vibration and joint position sense

Question 7

Lhermitte’s sign

Answer 7

Lhermitte’s Sign - neck flexion causes crepitus (grating sound) and/or paraesthesia down the spine

Question 8

Investigations

Answer 8

Spinal X-Ray (lateral)