Spine: Spondylosis

Question 1

Define Spondylosis

Answer 1

Progressive degeneration process affecting the cervical vertebral bodies and intervertebral discs, causing compression of the spinal and/or nerve roots (cervical spondylosis)

Question 2

Aetiology of Spondylosis

Answer 2

Osteoarthritic degeneration of vertebral bodies producing osteophytes
Osteophytes protrude on the exit foramina and spinal canal
- Compression of nerve roots → radiculopathy
- Compression of the spinal cord → myelopathy

Question 3

Risk factors of Spondylosis

Answer 3

>40 
Head or neck trauma
PMHx cervical spine injury 
Myofascial strain
Male

Question 4

Symptoms of Spondylosis

Answer 4

Spontaneous onset of neck pain (Usually multiple episodes over time)
Cervical muscle pain and spasm (scalene, trapezius, interscapular, paraspinal muscles)
Headache or occipital pain (Referred components e.g. occipital pain, cluster, tension)
Weakness or numbness
Presence of radiating arm pain (Distal to the shoulder = radiculopathy)
Atypical chest pain, breast pain or pain in the face

Question 5

Signs of Spondylosis

Answer 5

Change in reflexes
Proximal and/or distal arm weakness
Atrophy or forearm/hand muscles 
Gait ataxia 
Cervical muscle spasm 
Reduced cervical range of motion
Sensory changes (mainly pain+temp. loss)

Lhermitte’s sign: Neck flexion produces crepitus and/or paraesthesia down the spine.
Hoffmann’s sign (flexion of the terminal thumb phalanx when rapidly extending the terminal phalanx of the 3nd or 3rd finger).

Question 6

Investigations for Spondylosis

Answer 6

Cervical MRI: Bone destruction | Spinal cord/nerve compression | intradural or epidural process
Cervical XR: Presence of degenerative joint disease or degenerative disc disease | fracture | instability
Cervical CT: Same as MRI
Cervical CT myelogram
Nerve conduction velocity: change in muscle denervation, localise the root of problem
Cervical nerve root block: positive if nerve block relieves the pain - localises a single root