spondylosis Flashcards
definition of spondylosis
progressive degenerative process affecting the cervical vertebral bodies and intervertebral discs
causing compression of the spinal cord and/or nerve roots
degeration with age is inevitable
wide clinical spectrum from asymptomatic to progressive spastic quadriparesis nad sensory loss due to compression of the cord (myelopathy)
aetiology of cervical spondylosis
osteoarthritic degeneration of vertebral bodies producing osteophytes - which protrude on the exit foramina and spinal canal, and compress nerve roots (radiculopathy) or the anterior spinal cord (myelopathy)
epidemiology of cervical spondylosis
mean age at dx is 48yrs
annual incidence = 107 per 100000in men and 64 per 100000 in women
sx of cervical spondylosis
neck pain/stiffness
arm pain - stabbing or dull ache (brachialgia)
forearm/wrist pain
paraesthesia, weakness, clumsiness in hands
weak and stiff legs
gait disturbance
atypical chest pain, breast pain or pain in the face
crepitus on moving neck
arm signs of cervical spondylosis
atrophy of forearm or hand muscles
segmental muscle weakness in a nerve root distrubution
hyporeflexia - in C5 and C6 lesions inverted reflexes may be seen as a result of LMN impairment at the level of compression and UMN impairment below the level
Hoffmann’s sign (flexion of the terminal thumb phalanx when rapidly extending the terminal phalanx of the 3nd or 3rd finger).
sensory loss - mainly pain and temperature
pseudoathetosis - writhing finger motions when hands are outstretched, fingers spread and eyes closed
muscle nerve root distribution
C5 - shoulder abduction and elbow flexion weaknesses
C6 - elbow flexion and wrist extension weaknesses
C7 - elbow extension, wrist extension, finger extension weakness
C8 - wrist flexion and finger flexion weakness
legs signs of cervical spondylosis - see in those with cervical cord compressions
increased tone, weakness, hyper-reflexia and extensor plantars
reduced vibration and joint position sense (spinothalamic loss is less common) with a sensory level (few segments below the level of cord compression)
Lhermitte’s sign in cervical spondylosis
neck flexion produces crepitus and/or parasthesia down the spine
Ix for cervical spondylosis
spinal XR (lateral)
MRI
needle EMG - may reveal a myotomal pattern of denervation
spinal XR lateral, in cervical spondolyis s
osteoarthritic change in the cervical spine
rarely diagnostic in non-traumatic cervical radiculopathy
Flexion and extension films are important in the setting of trauma, and are helpful to evaluate for possible subluxation of one vertebral over another
MRI in cervical spondylosis
assessment of root and cord compression and to exclude spinal cord tumour, and nerve root infiltration by tumour or granulomatous tissue
Many elderly people have some degree of cervical spondylosis and this may not be the cause of the symptoms.
pathogenesis of cervical spondylosis
degeneration of the annulus fibrosis (the tough coating of the intervertebral disk)
combined with osteophyte formation on the adjacent vertebrae
= narrowing of the spinal canal and intervertebral foramina
as the neck flexes and extends, the cord is dragged over the protruding bony spurs anteriorly and indented by a thickened ligamentum flavum posteriorly
signs of cervical spondylosis
limited, painful neck movement +- crepitus
Lhermitte’s sign
root compression (radiculopathy)
features of cord compression
features of radiculopathy - cervical spondylosis
pain/electrical sensations in arms or fingers at level of compression
numbness, dull reflexes, LMN weakness and muscle wasting of muscles innervated by root
features of cord compression - cervical spondylosis
progressive sx (increasing weakness, clumsy hands, gait disturbance)
UMN leg signs - spastic weakness, upgoing plantars
LMN arm signs (wasting, hyporeflexia)
incontinence, hesitency and urgency - late features
