Cervical spondylosis

Cervical spondylosis is a little known form of arthritis which affects the spine in particular the neck, leading to inflammation, pain and stiffness.

A good way of thinking about this is a form of ‘wear and tear’on your joints which naturally occurs as you age. This is similar to another form of arthritis called osteoarthritis which develops as part of the ageing process.

This condition affects both men and women and is more prevalent in older rather than younger people. Younger people are affected but to a far lesser extent.

Around 85% of adults over the age of 60 have cervical spondylosis compared to 15% of young adults (in their twenties).

(Source: NHS Choices/cervical-spondylosis)

This arthritis cannot be cured but there are a range of treatments available which can ease the symptoms and prevent any permanent damage.

Cervical spondylosis is discussed as follows in this section:

• How does cervical spondylosis occur?
• Causes of cervical spondylosis
• Symptoms of cervical spondylosis
• Diagnosis of cervical spondylosis
• Tests for cervical spondylosis
• Treatment for cervical spondylosis
• Managing cervical spondylosis

How does cervical spondylosis occur?

Before we discuss this condition it may be useful to learn more about the spine and how it works. Here is a brief overview:

Anatomy of the spine

The spine is the solid yet flexible structure which is also known as the vertebral column. It consists of a series of ring shaped bones or vertebrae which run from the base of the skull to the pelvis. These act as a form of housing for the spinal cord as well as enabling you to bend, twist and move.

The spinal column consists of vertebrae, spinal cord, soft discs and nerve roots.

The vertebrae form the structure of the spine: the soft discs or pads rest in between the ring shaped vertebrae and act as a cushion: the spinal cord runs through this column and transports messages from the brain to the body: the nerve roots protrude through small holes all the way down the spine.

The spine performs a range of important functions not least the fact that it enables us to walk upright compared to many other mammals.

What can go wrong with the spine?

This is an age related condition in which discs within the spine become worn down over time which leads to pain and stiffness in the neck. They bulge which weakens them and makes them prone to damage such as tears.

There are two sets of discs: facet joints and ‘intervertebral’ discs which become thinner and cause outgrowths or spurs of bone to form around the edges of these vertebrae.

Facet joints are discussed in detail in our ankylosing spondylitis section.

Plus the spaces between these vertebrae become narrower and these plus bone spurs cause the neck to stiffen which can compress the nerves and the spinal cord.

But this tends to be rare.

Causes of cervical spondylosis

There are two causes of cervical spondylosis which are:

• Ageing process: wear and tear on the joints
• Slipped disc

Ageing process

The ageing process is responsible for a series of changes to the body not least the joints. We know that many forms of arthritis are caused by growing older and there is not much you can do about damage accumulated over time.

The discs in the spine start to wear in the same way as many other joints in the body and become susceptible to diseases such as arthritis. To compensate for this bone spurs or ‘osteophytes’ form on the outside of the vertebrae which acts as a form of support but can cause the spine to become too rigid.

These bone spurs can compress nerves and even the spinal cord itself which causes a tingling feeling or a loss of sensation in your arms and legs.

The tendons and/or ligaments surrounding the spine become stretched and worn over time.

Slipped disc

The medical name for this is a ‘herniated disc’: this is a common condition caused by one of the discs splitting, resulting in an overspill of the soft inner lining.

If this lining presses against a nerve, for example a nerve within the neck then it can cause acute pain, numbness and weakness in the limbs.

It may lead to a compression of the spinal cord known as ‘cervical myelopathy’.

A slipped disc tends to occur in younger people.

Symptoms of cervical spondylosis

Most people develop cervical spondylosis as they get older but not everyone develops any symptoms. It is commonly assumed that if you develop cervical spondylosis then you will automatically get neck pain and stiffness but this is not always the case.

There are people with this condition who not display any symptoms.

Some people have symptoms which come and go. But others are unlucky enough to experience chronic pain which then persists for a long period of time.

Headaches are another symptom but these happen only occasionally.

Most people experience mild or moderate symptoms but there are others who develop a slipped disc or trapped nerve. Another complication is where the spinal cord becomes pinched due to a narrowing of the vertebrae.

These cause pain, numbness and a ‘pins and needles’feeling in the arms or legs. It is difficult to walk and/or co-ordinate your movements.

Diagnosis of cervical spondylosis

If you are suffering from unexplained neck pain and stiffness or have a tingling sensation in your arms then visit your GP. Do this if you have a weakness in any of your limbs or are having problems with your co-ordination.

Your GP will suspect a case of cervical spondylosis but will refer you for tests to confirm this.

To start with he/she will ask you about your symptoms followed by questions about your medical history. This is then followed by a physical examination.

Your GP will look at the range of movement in your neck and spine. He/she will ask you to tilt and rotate your neck to see if there is any stiffness and if so, how much. He or she will also test your reflexes and ask you to walk up and down the room to check your balance and co-ordination.

Tests for cervical spondylosis

You will then be referred for tests. These include X-rays, MRI scan and myelogram.

An X-ray will show bone spurs in the spinal column but are unable to show a slipped disc or trapped nerves. These can only be seen on an MRI scan.

A myelogram is an invasive procedure in which a special dye is injected into your spine to highlight your spinal cord and nerves. Both of these can be seen during an X-ray or an MRI scan.

Treatment for cervical spondylosis

The aim of any treatment is to ease your symptoms and prevent any permanent damage to your spinal cord or nerves. If this occurs then it can lead to a disability.

Treatment options include painkillers such as paracetamol, exercise and a few lifestyle changes.

You will be prescribed non-steroidal anti-inflammatory drugs (NSAID’s) which are effective at reducing inflammation. An example of these is Ibuprofen. They are an effective group of painkillers and preferred to aspirin due to fewer side effects.

Other drugs include codeine (another painkiller), muscle relaxants, Gabapentin and Amitriptyline. Exercise such as walking or swimming can help as can ensuring that you maintain a good posture when stood up or sat down.

Surgery is only recommended in severe cases. These include severe pain due to trapped nerves or a compressed spinal cord.

For more information about this visit our treatment for arthritis section.

Managing cervical spondylosis

There is no cure for this condition so the emphasis is on relieving pain and other symptoms in order to prevent any long term damage. They will also make your day to day living that much easier.

These self help measures include neck and back massage: wearing a soft collar although avoid wearing this for a long period of time: exercise such as swimming or stretching exercises for your neck: painkillers (see treatment above): techniques to improve your posture and relaxation, e.g. meditation.

Check your posture at work. Ensure that your workstation is correctly set up and avoid slumping over your desk especially later in the afternoons.

There is more useful information in our living with arthritis section.