Cervical spondylosis

 

Alternative Names

Cervical osteoarthritis; Arthritis - neck; Neck arthritis; Chronic neck pain

Definition

Cervical spondylosis is a disorder in which there is abnormal wear on the cartilage and bones of the neck (cervical vertebrae). It is a common cause of chronic neck pain.

Causes

Cervical spondylosis is caused by chronic wear on the cervical spine. This includes the disks or cushions between the neck vertebrae and the joints between the bones of the cervical spine. There may be abnormal growths or spurs on the bones of the spine (vertebrae).

Over time these changes can press down on (compress) one or more of the nerve roots. In advanced cases, the spinal cord becomes involved. This can affect not just the arms, but the legs as well.

Everyday wear and tear may start these changes. People who are very active at work or in sports may be more likely to have them.

The major risk factor is aging. By age 60, most persons show signs of cervical spondylosis on x-ray. Other factors that can make a person more likely to develop spondylosis are:

Symptoms

Symptoms often develop slowly over time. But they may start or get worse suddenly. The pain may be mild, or it can be deep and so severe that you are unable to move.

You may feel the pain over the shoulder blade. Or it may spread to the upper arm, forearm, or fingers (in rare cases).

The pain may get worse:

  • After standing or sitting
  • At night
  • When you sneeze, cough, or laugh
  • When you bend the neck backwards or walk more than a few yards

You may also have weakness in certain muscles. Sometimes, you may not notice it until your doctor examines you. In other cases, you will notice that you have a hard time lifting your arm, squeezing tightly with one of your hands, or other problems.

Other common symptoms are:

Less common symptoms are:

  • Loss of balance
  • Loss of control over the bladder or bowels (if there is pressure on the spinal cord)

Exams and Tests

A physical exam may show that you have trouble moving your head toward your shoulder and rotating your head.

Your health care provider may ask you to bend your head forward and to each side while putting slight downward pressure on the top of your head. Increased pain or numbness during this test is usually a sign that there is pressure on a nerve in your spine.

Weakness or loss of feeling can be signs of damage to certain nerve roots or to the spinal cord.

A spine or neck x-ray may be done to look for arthritis or other changes in your spine.

MRI of the neck is done when you have:

  • Severe neck or arm pain that does not get better with treatment
  • Weakness or numbness in your arms or hands

EMG and nerve conduction velocity test may be done to examine nerve root function.

Treatment

Your doctor and other health professionals can help you manage your pain so that you can stay active.

  • Your doctor may refer you for physical therapy. The physical therapist will help you reduce your pain using stretches. The therapist will teach you exercises that make your neck muscles stronger.
  • The therapist can also use neck traction to relieve some of the pressure in your neck.
  • You may also see a massage therapist, someone who performs acupuncture, or someone who does spinal manipulation (a chiropractor, osteopathic doctor, or physical therapist). Sometimes a few visits will help with neck pain.
  • Cold packs and heat therapy may help your pain during flare-ups.

A type of talk therapy called cognitive behavioral therapy may be helpful if the pain is having a serious impact on your life. This technique helps you better understand your pain and teaches you how to manage it.

Medicines can help your neck pain. Your doctor may prescribe nonsteroidal anti-inflammatory medications (NSAIDs) for long-term pain control. Narcotics may be prescribed if the pain is severe and does not respond to NSAIDs.

If the pain does not respond to these treatments, or you have a loss of movement or feeling, surgery is considered. Surgery is done to relieve the pressure on the nerves or spinal cord.

   

Outlook (Prognosis)

Most patients with cervical spondylosis have some long-term symptoms. These symptoms improve with non-surgical treatment and do not need surgery.

Many people with this problem are able to maintain active lives. Some patients will have to live with chronic pain.

Possible Complications

When to Contact a Medical Professional

Call your health care provider if:

  • The condition becomes worse
  • There are signs of complications
  • You develop new symptoms (such as loss of movement or feeling in an area of the body)
  • You lose control of your bladder or bowels (call right away)

References

Rosenbaum RB, Kula RW. Disorders of bones, joints, ligaments, and meninges. In: Bradley WG, Daroff RB, Fenichel GM, Jankovic J, eds. Bradley’s Neurology in Clinical Practice. 6th ed. Philadelphia, Pa.: Elsevier Saunders; 2012:chap 73.

Cohen I, Jouve C. Cervical radiculopathy. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia, Pa.: Elsevier Saunders; 2008:chap 4.

Takagi I, Eliyas K, Stadlan N. Cervical spondylosis: an update on pathophysiology, clinical manifestation, and management strategies. Dis Mon. 2011;57:583-591

Review Date: 4/16/2013
Reviewed By: C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

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