Spondylosis

Question 1

Define cervical spondylosis.

Answer 1

natural degenerative process of the cervical motion segment which can lead to cervical radiculopathy, cervical myelopathy, or axial neck pain.

Ranges from asymptomatic to progressive spastic quadriparess and sensory loss due to compression of the cord (myelopathy).

Question 2

What is the pathogenesis of spondylosis?

Answer 2

Degeneration of the annulus fibrosus (the tough coating of the intervertebral discs), + osteophyte formation on the adjacent vertebra –> 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 3

What are the signs and symptoms of cervical spondylosis?

Answer 3

• Neck stiffness (but common in anyone >50yrs old),
• crepitus on moving neck,
• stabbing or dull arm pain (brachialgia),
• forearm/wrist pain.
• Limited, painful neck movement ± crepitus (examine gently).
• Neck flexion may produce tingling down the spine (Lhermitte’s sign,). NB: this does not distinguish between cord or roots (or both) involvement.

Question 4

What are some differentials for cervical spondylosis?

Answer 4

• MS;
• nerve root neurofibroma;
• subacute combined degeneration of the cord (low B12);
• compression by bone or cord tumours.

Question 5

What is the management of cervical spondylosis?

Answer 5

• If red flags –> urgent MRI and specialist referral
• Analgesia
• Encourage gentle activity
• Cervial collars may provide comfort BUT prolong symptoms
• MRI and neurosurgical referral if symptoms persist 4-6 weeks e.g. for interlaminar cervical epidural injections, transforaminal injections, surgical decompression (laminectomy or discectomy)

Question 6

What is the difference between discectomy vs laminectomy surgery?

Answer 6

Anterior approach - discectomy

Posterior approach - laminectomy