π Cervical Spondylosis Overview
π§ Cervical spondylosis is a degenerative condition of the cervical spine, caused by age-related wear and tear of discs, vertebrae, and joints.
It is extremely common β affecting up to 85% of adults over 60 β and is the most common cause of cervical myelopathy in the UK.
π About
- π’ Leading cause of chronic neck pain in older adults.
- β‘ Can cause radiculopathy (nerve root compression) and myelopathy (cord compression).
- π Most commonly affects C5-6, C6-7, and C3-4 levels.
π¬ Aetiology
- β³ Disc Degeneration: Loss of hydration β reduced disc height β instability.
- 𦴠Osteophytes: Bone spurs form as stabilisation attempt, narrowing foramina/canal.
- βοΈ Facet Hypertrophy: Enlarged joints contribute to canal narrowing.
- π Ligament Thickening: Thickened ligamentum flavum compresses cord.
- π₯ Herniated Disc: Central β cord compression, lateral β radiculopathy.
π¨ Red Flag: Cervical canal narrowing below 13 mm risks cord compression.
Symptoms of myelopathy (gait disturbance, hand clumsiness, bladder dysfunction) = urgent MRI & specialist referral.
π©Ί Clinical Features
- π§ββοΈ Neck Pain & Stiffness β worsens with movement, limited ROM.
- β‘ Radiculopathy: Dermatomal pain, numbness, tingling, weakness.
- π§ Myelopathy: Spasticity, gait ataxia, hyperreflexia, Babinski sign, bladder/bowel involvement in advanced cases.
- π Cervical Crepitus: βGrindingβ with neck movement.
π§ͺ Investigations
- π₯ MRI: Gold standard β shows cord compression, T2 hyperintensities (gliosis).
- π‘ X-Ray: Osteophytes, alignment, disc space narrowing.
- π CT: Excellent for bony detail (for surgical planning).
- β‘ NCS/EMG: Helps distinguish radiculopathy from peripheral neuropathy.
π Management
- π§ Conservative: NSAIDs, physio, posture training, ergonomic modification.
- π Interventional: Epidural steroids, facet joint injections, radiofrequency ablation.
- πͺ Surgical: ACDF, laminectomy, foraminotomy, disc replacement for progressive neurological deficits.
π Prognosis
- π Chronic but manageable with early intervention.
- π Many improve with conservative therapy + lifestyle adaptation.
- β οΈ Severe untreated myelopathy β irreversible deficits.
π‘ Prevention
- πͺ Good posture & ergonomic setup.
- ποΈ Regular exercise & neck strengthening.
- π Quit smoking β slows degeneration.
- βοΈ Maintain healthy weight to reduce stress on spine.