CERVICAL SPONDYLOSIS

= Arthritis of the neck

Degenerative condition Affects the vertebral bodies, the

intervertebral discs ,the facet joints and eventually the contents of the spinal canal

Involves the degeneration of cartilage and the formation of osteophytes (spurs)

Results in pain and stiffness Worsens with age

Definition

Pathophysiology

Denegation that occurs naturally with age

Occurs in the facet joints and the intervertebral discs

Discs lose water and weaken

Movement segment

Increase in mechanical stress at cartilage end plates with an increase in pressure at the facet joints

Cartilage therefore gets worn away and results in bone on bone contact

Body response is the formation of osteophytes=spurs

Supports the decaying vertebrae

Creates a narrow space for nerves to pass

Disc: Decreased elasticity of annulus fibrosis Loss of fluid in nucleus pulposesTherefore unable to withstand compression

forces and bulges decrease in disc height

Formation of osteophytes:◦ Forms where tension is the greatest◦ Forms at the edges of the vertebrae

Facet joints In closer contact due to decreased height of

the disc

Stretching of the capsule due to inferior facet moving down on the superior facet

Facet joints move into a position of extension

and therefore experience an increase of stress during normal daily activities

Vertebral body: Development of sclerosis= hardening of

tissue/structures

Intervertebral foramen: Decreased due to the formation of

osteophytes and loss of disc height

Spinous processes: Formation of a false joint due to the spinous

processes coming into contact with one another

Normal versus abnormal cervical segmentsCollapse of intervertebral disc and

joint space

Three stages occur during degeneration1. Dysfunction

◦ Dysfunction of the trunk fascia, muscles , ligaments, capsule, neural structures and z-joints.

◦ Results from mechanical stress , injuries and overuse injuries

2. Instability◦ Disc mal-alignment and degeneration due to a

loss of protection from these structures ◦ Results in segmental stability

3. Stabilisation period◦ This is the body's effort towards healing

Age –especially above 60 years Family history of neck pain Overweight Sports Occupations involving excessive

neck motion/overhead working Previous neck injury/trauma Ruptured/slipped disk

Causes and Risk Factors

Pathology of the cervical spine Spur formation with narrowing of the

disc space

Signs and Symptoms Can develop

◦ Slowly◦ Sudden onset

Headaches Neck stiffness Weakness

◦ Difficulty with lifting arm or squeezing hand

Abnormal sensations or numbness◦ Shoulder/arms/legs

Pain◦ Mild◦ Severe

Location: behind neck , m.trapezius, upper arm, forearm and fingers

Aggravated by: ◦ Sudden movements◦ Stretching at end range

Worse in the morning

Signs and Symptoms

Signs and Symptoms Loss of balance Muscle spasms of

neck and shoulders Grinding/popping

noise with movement Reduced reflexes Difficulty rotating

head in all directions

Conservative: Physiotherapy

◦ Strengthening of neck muscles◦ Stretching◦ Neck traction◦ Posture therapy◦ Ice/hot packs◦ Care of the neck and advice◦ Passive mobilisations

Medical Management

Medication◦ NSAIDS (aspirin,ibuprofen)◦ Muscle relaxants◦ Steroid injections◦ Anti convulsants/antidepressants◦ Narcotics/opiods (not on a daily basis)

Soft collars NB ! Short term only!◦ Limits neck motion

Medical Management

Surgery (foraminotomy ,laminectomy , spinal fusion)◦ Uncommon◦ If conservative management fails◦ Only for severe pain◦ Neurological symptoms

Medical Management

Long lasting Cervical Radicular Pain Managed With Surgery , Physiotherapy , or a Cervical Collar: A Prospective ,Randomized Study .

Compared the effect of surgery, physiotherapy and a cervical collar on cervical radicular pain as a result of cervical spondylosis

Included 81 patients who have experienced cervicobrachial pain for at least 3 months

Research

The pain must be a direct result from a root compression with or without a bulging disc

Patients were randomly allocated to each treatment method

It was concluded at the end of a 12 month evaluation that either method was a successful as the next

This implied that the condition is dominant in its degeneration

Persson,L.C.,Carlsson,C.,Carlsson,J.1997.Long-Lasting Cervical Radicular Pain Managed With Surgery ,Physiotherapy , or a Cervical Collar : A Prospective ,Randomized Study . Sweden : Lippincott , Williams & Wilkins.

Fox.M.L.2009.American Academy of Orthopaedic Surgeons.

http://orthoinfo.acios.org/topic.cfmRetrieved on 12 May 2012.

References

Vorvick,L.J .,Benjamin,C and Zieve,D.2011.National Center for Biotechnology Information:US National Library of Medicine.

www.ncbi.nlm.nih.gov/pubmedhealth/PMH0014721Retrieved on 12 May 2012.

Barnes,R.2011.NEUROMUSCULAR-SKELETAL REHABILITATION DICTATE.(Unpublished dictate.) University of the Free State , Free State.