Cervical Spondylitis - Causes, Symptoms, Diagnosis, and Management

Introduction

Cervical spondylosis is the colloquial term for age-related wear and tear in the cervical spine resulting in neck pain, stiffness, and associated symptoms. The pain and stiffness can sometimes even radiate to the upper and lower back. The condition is also known as arthritis or osteoarthritis of the neck.

What Are the Components of the Cervical Spine?

The entire spine comprises 24 vertebrae and the cervical spine, which connects the head to the thorax, contains seven such vertebrae beginning at the skull base. The spinal cord and its nerve bundles pass through a tunnel-like structure composed of the foramina of these vertebrae relaying messages between the brain and the body. Each pair of vertebrae articulate at three joints called the intervertebral disk and two facet joints, with cartilages that cushion the ends of the bones to prevent wear and tear by everyday friction. The vertebrae are connected together by ligaments.

How Does Spondylosis Occur?

The cartilages in between the bones wear out over time. The disks in between the vertebrae also reduce in volume, drying, and cracking with age. The ligaments also thicken over time. Bone spurs may form in areas of repeated friction that have lost cartilaginous protection. All of these changes are defined as spondylosis.

What Is the Incidence Rate for Cervical Spondylosis?

Age-related changes in the spine are a natural occurrence that likely begins around the early 30s. At around 60 years of age, the occurrence rate of this disease is around nine in ten individuals.

Who Are More Prone to Develop Cervical Spondylosis?

Aging is the principal factor for the occurrence of cervical spondylosis. Other factors that may increase the risk are as follows;

• Smokers.

• Genetic predisposition.

• Professional hazards where neck strain is repetitive, such as painting, carpentry, etc.

• History of neck injury due to trauma, such as accidents.

• Professionals engaged in heavy lifting.

• Professional drivers and truckers.

What Are the Causative Factors Behind Cervical Spondylosis?

The spine degenerates due to normal wear and tear as individual ages. The factors that ultimately result in spondylosis are as follows;

• Degeneration of the spinal disks.

• Disk herniation.

• Osteoarthritis.

• Osteophytes or bone spurs.

What Does a Patient With Cervical Spondylosis Experience?

Cervical spondylosis may be asymptomatic. However, certain symptoms are seen that are enlisted as follows;

• Pain or stiffness of the neck.

• Soreness of the neck.

• Spasms in the neck muscles.

• Neck movement causes sounds such as clicking or grinding.

• Vertigo.

• Frequent headaches and backaches.

How Is Cervical Spondylosis Diagnosed?

A physical examination corroborated by medical imaging is the method used to diagnose spondylosis. The physical examination includes the following;

• Checking for the flexibility of the neck.

• Strength of muscles in the upper and lower extremities.

• Evaluating the reflexes of the patient.

• The gait of the patient.

Diagnostic imaging tests are also done to confirm the diagnosis, which includes the following;

• X-rays.

• Computed tomography (CT) scans.

• Magnetic resonance imaging (MRI) scans.

• Myelograms.

• Electromyograms.

What Are the Treatment Modalities for Cervical Spondylosis?

Asymptomatic cases require no treatment. However, conservative non-surgical treatments may be prescribed in symptomatic cases that are as follows;

• Physiotherapy.

• Ice application.

• Heat application.

• Massage therapy.

• Pharmacotherapy or medication.

• Using braces and collars.

• Steroid injections in the following regions:

  • Cervical epidural block.

  • Cervical facet joint block.

  • Medial branch block.

  • Radiofrequency ablation.

In severe cases of cervical spondylosis that results in cervical myelopathy or cervical radiculopathy, a surgical option is considered to remove and reshape bone spurs, spinal fusion, or laminectomy surgeries.

What Is Spinal Fusion?

Spinal fusion is a surgical procedure where the vertebrae are permanently joined or fused into one single solid bone with no spaces between them. The vertebrae are the small, interlocking bones of the spine collectively termed a vertebral column. Bone grafts fill the naturally occurring space between the separate vertebrae, which is filled up and sealed when the bone heals.

What Are the Postoperative Complications of Spinal Fusion?

As with any major surgical procedure, spinal fusion surgery may also carry risks of certain complications, as follows;

• Infection of the surgical site.

• Blood clots in the head and neck or extremities.

• Dissemination of blood clots to the lungs may be fatal.

• Bleeding and blood loss may lead to death.

• Respiratory distress.

• Increased risk of a heart attack during an ongoing surgery.

• Increased risk of strokes.

• Delayed or inadequate wound healing due to systemic diseases such as diabetes.

• Allergic or anaphylactic reactions to medications or anesthetic agents administered.

Certain rare complications may also be seen, enlisted as follows;

• Infection in the treated vertebrae.

• Damage to a spinal or cranial nerve or nerve root leads to weakness, pain, bowel or bladder problems, or neuralgia pain.

• Stress on the bones adjacent to the surgically treated vertebrae due to loss of flexibility and increased stiffness.

• Persistent pain at the donor bone graft site if an autograft is used.

• Allergic reaction caused by synthetic bone grafts.

The most severe complications, as mentioned above, are blood clots, disseminated clots to other sites, and an infection of the surgical site, which have a high chance of occurring during the first few weeks of the postoperative recovery phase.

Removal of the hardware is necessary in case of postoperative pain or discomfort, and emergency help should be sought if one experiences any of the symptoms of a blood clot enlisted as follows;

• Sudden swelling in the calf, ankle, or foot.

• Redness or tenderness is seen either above or below the knee.

• Calf pain.

• Groin pain.

• Shortness of breath or difficulty breathing.

A patient should seek emergency help if any of the symptoms of infection are seen, enlisted as follows;

• Redness or swelling at the edges of the surgical site.

• Fluid drainage, such as blood or pus from the surgical site.

• Fever, chills, or elevated body temperature over 100 degrees Fahrenheit.

• Shaking and malaise.

What Is Laminectomy?

Laminectomy is also known as open decompression. It is a surgical procedure aimed at the treatment of central spinal stenosis. The spinal canal narrowing is also a possible indication of this procedure. The posterior part of the vertebra or lamina is removed to provide more space for the compressed spinal cord or nerve roots. When non-surgical treatments such as physiotherapy, pain medications, and epidural steroid injections fail to improve after 8 to 12 weeks, this procedure may be considered depending on several factors.

What Are the Risks of a Laminectomy Procedure?

Any surgical procedure is not free from the risk of intraoperative or postoperative complications such as;

• Bleeding from the surgical site.

• Infection of the surgical site.

• Blood clots in the legs can disseminate to the lungs.

• Injury to the spinal cord or nerve root.

• General anesthesia-related risks.

• Injury to the local nerve or blood vessels in and around the surgical site.

• Rarely the pain may either not subside or be aggravated postoperatively.

What Does Postoperative Recovery Look Like After Surgery?

A postoperative hospital stay of one to four days is typically required following laminectomy. The patient is kept under observation by the hospital staff for any complications. In addition, a physical therapist is appointed who works with the patient during the hospital stay to help with a guided rehabilitation program.

Recovery typically depends on the patient's fitness and level of activity before the surgical procedure is conducted. Physical therapy may be advised to improve presurgical activity levels to encourage better postoperative recovery. It typically takes four to six weeks until normal function is established.

Is Cervical Spondylosis Preventable?

Cervical spondylosis is an age-related condition. Thus, there are no preventive measures as such. However, preventing repetitive strain from profession or hobbies, using self-help guides, periodic consultations with specialists after the specified age of occurrence, and physical therapies as and when necessary, could likely delay and deter the rate of degeneration and degradation of the cervical spine.

Conclusion

Cervical spondylosis is the common term for age-related wear and tear in the cervical spine. It results in neck pain, stiffness, and associated symptoms. Age-related changes in the spine are a natural occurrence that likely begins at around the age of 30 years. At around 60 years of age, the occurrence rate of this disease is around nine in ten individuals. There are no preventive measures as such; however, the rate of degeneration may be slowed by preventing the rate of wear and tear.