Spondolysis

Question 1

Define:

Answer 1

Progressive degenerative process affecting the CERVICAL vertebral bodies and intervertebral discs that leads to cord compression of the spinal cord and/or the nerve roots

Question 2

Aetiology:

Answer 2

Degeneration of the annulus fibrosus in the intervertebral disc

Osteoarthritic degeneration of the vertrebral bodies leads to osteophytes which protrude on the foramina and spinal cord compressing them

This leads to compression of :

• Nerve root = radiculopathy
• Anterior spinal cord = myelopathy

This is wear and tear ageing

Question 3

Epidemiology:

Answer 3

common age of diagnosis is 48

More common in males

Question 4

Symptoms:

Answer 4

Neck pain and stiffness
Creptitus on moving the neck 
Arm pain (can be stabbing or dull)
Parasthesia in hands 
Weakness 
Clumsiness in hands 
Gait disturbances 
Atypical chest pain 
Incontinence, urgency and hesitancy - later stages 
Breast and face pain

Question 5

Signs in the arms:

Answer 5

LMN signs:

• pain/electrical sensation in arms
• Dull reflexes
• Muscle wasting
• atrophy
• hyporeflexia
• sensory loss (mainly the temperature and pain)
• segmental muscle weakness

Question 6

Signs in the legs:

Answer 6

UMN signs:

• Extensor plantar responses
• Hyperreflexia
• Spastic weakness
• increased tone

Question 7

Signs in the neck:

Answer 7

o Lhermitte’s Sign - neck flexion causes crepitus (grating sound) and/or paraesthesia down the spine.
o Movement is painful and limited.
o Neck signs do not help decide if cord/roots/both are involved

Question 8

Investigations:

Answer 8

• Spinal X-Ray (lateral)
o Can detect osteoarthritic change
o Rarely diagnostic if non-traumatic
• MRI
o Allows assessment of root and cord compression
o Helps exclude spinal cord tumour and nerve root infiltration by granulomatous tissue
• Needle Electromyography (EMG)