Spondylosis is a general term for arthritic breakdown of the intervertebral joints and spinal discs and is characterized by abnormal bone growth and progressive loss of the normal structure of spinal discs, or disc degeneration. It occurs in the all regions of the spine, but frequently occurs in the neck (cervical vertebrae). There are three primary groups of patients. Patients presenting only with neck pain due to arthritis are the most common. Some patients develop arm pain (radiculopathy) due to pinching of a spinal nerve. The least common group consists of those who develop difficulty with walking and loss of hand function due to compression of the spinal cord (myelopathy). Some patients will have symptoms from two or all three of these groups.
Figure 1: X-Ray of the neck
spine (spondylosis) at C5-6 level.
Note osteophyte formation, (white arrow) and
disc space narrowing (black arrow).
With arthritis of the spine, abnormal bone growth of the vertebrae occurs, resulting in boney ridges or bone ñspursî at the point of motion next to the discs and on the facet joints. The ligaments which connect the vertebrae (ligamentum flavum) also hypertrophy, and in so doing, may encroach on the space of the spinal canal. Progressive degeneration of the discs between vertebrae develops from mineral deposits (calcification) within the discs and eventual disc herniation. All of these pathologies can result in narrowing (stenosis) of the nerve foramina or the spinal canal. (see Figure 1 ).
Symptoms can resemble those caused by a herniated disc but usually are not as severe. General symptoms include stiffness, pain on movement, and radiating pain and abnormal skin sensations (tingling, burning, prickling, ñpins and needlesî) in extremities due to pressure placed on a nerve root (spondylotic radiculopathy) at the spine, a condition called paresthesia. Compression of the spinal cord can occur with development of neurological deficits of numbness, weakness, and loss of function in the extremities (see Cervical Stenosis section below). Headaches, loss of balance, and tinnitus can also occur.
Physical examination typically demonstrates a limited ability to bend the neck forward, backward, and to the side and to rotate the head. Plain X-rays are used in the diagnosis of spondylosis of the spine, as the degenerative process produces characteristic X-ray changes, demonstrating a decreased disc space and smaller than normal neural foramina. Small outgrowths of new bone, known as osteophytes, are also seen with X-ray examination on the facet joints and on the rims of vertebrae that are closes to the disc tissue. A CT scan or MRI may be used as well as an EMG to evaluate neuromuscular involvement, which may be asymptomatic, or to rule out neurologic diseases.
Treatment objectives are relief of pain and relief of any neurologic symptoms of compression of the spinal nerves or spinal cord. Nonoperative treatment for cervical spondylosis may include temporary brace immobilization, traction, physical therapy (exercises, strength training, massage, mobilization, and physical modalities such as ultrasound, electrical stimulation, heat), and medications (analgesics, NSAIDs, muscle relaxants, corticosteroids).
If improvement is not achieved in a nonoperative program over 2 to 3 months, surgical treatment may be considered. In most cases of symptomatic spondylosis and neck pain, when there are no neurologic problems, surgical treatment is not advisable. However, in severe cases of cervical spondylosis where there is loss of function or sensation, due to significant spinal cord compression and damage, surgery may be indicated. At surgery, abnormal bone growths and arthritis compressing the spinal cord are removed and the spine may need to be fused along one or more vertebrae in order to restore stability and prevent future problems.
The prognosis of symptomatic cervical spondylosis depends on the stage of disease and the degree of neurologic injury and dysfunction, if any. The vast majority of patients have mild symptoms and no neurologic problems and respond well to nonoperative treatments. Other patients have chronic conditions requiring longer or ongoing treatment or surgery. The most serious development of spondylotic conditions is cervical spondylotic myelopathy, or compression of the neck spinal cord with cord damage. However, even in this condition surgical outcomes can be very successful with long-term improvement in symptoms and function achieved in up to 80% of cases.