Cervical spondylosis

Cervical spondylosis: Description, Causes and Risk Factors:Abbreviation: CS.Your neck is part of a long flexible column, known as the spinal column or backbone, which extends through most of your body. The cervical spine (neck region) consists of seven bones (C1-C7 vertebrae), which are separated from one another by intervertebral discs. These discs allow the spine to move freely and act as shock absorbers during activity.Attached to the back of each vertebral body is an arch of bone that forms a continuous hollow longitudinal space, which runs the whole length of your back. This space, called the spinal canal, is the area through which the spinal cord and nerve bundles pass. The spinal cord is bathed in cerebrospinal fluid (CSF) and surrounded by three protective layers called the meninges (dura, arachnoid, and pia mater).At each vertebral level, a pair of spinal nerves exit through small openings called foramina (one to the left and one to the right). These nerves serve the muscles, skin and tissues of the body and thus provide sensation and movement to all parts of the body. The delicate spinal cord and nerves are further supported by strong muscles and ligaments that are attached to the vertebrae.Cervical spondylosis is the degeneration of the joints in the neck. It becomes increasingly more common as people age. More than 85% of people over age 60 are affected. One feature of the degeneration is that the edges of the vertebrae often develop small, rough areas of bone called osteophytes. Also, over many years, the discs become thinner. This degeneration is a normal ageing process which can be likened to having 'wrinkles in the spine.' In many people, the degeneration does not cause any symptoms.However, in some people, the nearby muscles, ligaments, or nerves may become irritated or 'pressed on' by the degenerative changes. So, cervical spondylosis often causes no problems but can be a cause of neck pain, particularly in older people.Disk degeneration and bone spurs: This commonly result as the disc degenerates and loses water content. In children and young adults, discs have high water content. As we get older, our disks begin to dry out and weaken. This problem causes settling, or collapse, of the disc spaces and loss of disc space height.As the facet joints experience increased pressure, they also begin to degenerate and develop arthritis, similar to the hip or knee joint. The cartilage that covers and protects the joints wears away.If the cartilage wears away completely, it can result in bone rubbing on bone. To make up for the lost cartilage, your body may respond by growing new bone in your facet joints to help support the vertebrae. Over time, this bone overgrowth — called spurs — may narrow the space for the nerves to pass through (stenosis).There are several factors that increase your risk for cervical spondylosis. The following have all been linked to higher risks of neck pain and cervical spondylosis:Genetics - if your family has a history of neck pain.
  • Smoking - clearly linked to increased neck pain.
  • Occupation - jobs with lots of neck motion and overhead work.
  • Mental health issues - depression/anxiety.
  • Injuries/trauma - car wreck or on-the-job injury.
Symptoms of Cervical spondylosis:Cervical spondylosisNeck pain (may radiate to the arms or shoulder).
  • Loss of sensation or abnormal sensations of the shoulders, arms, or legs.
  • Weakness of the arms or legs.
  • Neck stiffness that progressively becomes worse.
  • Loss of balance.
  • Headaches, particularly in the back of the head.
  • Muscle spasms.
  • Loss of control of the bladder or bowels (if spinal cord is compressed).
  • You may feel or hear grinding or popping in the neck when you move.
  • General tiredness and anxiety - can be present.
Diagnosis Cervical spondylosis:Your doctor may supplement your evaluation with blood tests, and, if necessary, consult with other medical specialists. Other tests which may help your doctor confirm your diagnosis may include:X-rays: These pictures are traditionally ordered as a first step in imaging the spine. X-rays will show aging changes, like loss of disk height or bone spurs.
  • Magnetic resonance imaging (MRI): This study can create better images of soft tissues, such as muscles, disks, nerves, and the spinal cord.
  • Computed tomography (CT) scans: This specialized x-ray study allows careful evaluation of the bone and spinal canal.
  • Myelography: This specific x-ray study involves injecting dye or contrast material into the spinal canal. It allows for careful evaluation of the spinal canal and nerve roots.
  • Electromyography (EMG): Nerve conduction studies and electromyography may be performed by another doctor to look for nerve damage or pinching.
Treatment:After conducting the necessary tests to identify the problem in the cervical spine, a treatment plan will be developed. Various treatment options are available, and can be subdivided into two categories:Nonoperative Treatment.
  1. Operative Treatment.
Nonoperative Treatment: It is believed in allopathic system of medicine that nonoperative treatment of cervical degenerative disease provides good-to-excellent results in over 75% of patients. A multidisciplinary approach includes:Immobilization.
  • Physical Therapy.
  • Medications.
  • Homeopathic Systems.
Medications: Several medications may be used together during the first phase of treatment to address both pain and inflammation.Acetaminophen: Mild pain is often relieved with acetaminophen.
  • Non-steroidal anti-inflammatory drugs (NSAIDs): Often prescribed with acetaminophen, drugs like ibuprofen and naproxen are considered first-line medicines for neck pain. They address both pain and swelling, and may be prescribed for a number of weeks, depending on the specific problem. Other types of pain medicines can be considered if you have serious contraindications to NSAIDs, or your pain is not well controlled.
  • Muscle relaxants: Medications such as cyclobenzaprine or carisoprodol can also be used in the case of painful muscle spasms.
Homeopathic remedies may include: Calcarea carb, Lycopodium, Lachnanthes, Kalmia Lat, Cimicifuga, Rhus Tox, and Bryonia.Other Nonoperative Treatment Options of Cervical spondylosis:Soft Collars: These collars limit neck motion and allow the muscles of the neck to rest. Soft collars should only be worn for short periods of time because long-term wear can decrease the strength of neck muscles.
  • Ice, heat, other modalities: Careful use of ice, heat, massage, and other local therapies can help relieve symptoms.
  • Steroid-Based Injections: Many patients find short-term pain relief from steroid injections. Various types of these injections are routinely performed. The most common procedures for neck pain include:
  • Cervical epidural block: In this procedure, steroid and anesthetic medicine is injected into the space next to the covering of the spinal cord ("epidural" space). This procedure is typically used for neck and/ or arm pain that may be due to a cervical disk herniation, also known as radiculopathy or a "pinched nerve."
  • Cervical facet joint block: Steroid and anesthetic medicine is injected into the capsule of the facet joint in this procedure. The facet joints are located in the back of the neck and provide stability and movement. These joints can develop arthritic changes that may contribute to neck pain.
  • Medial branch block and radiofrequency ablation: This procedure is used in some cases of chronic neck pain. It can be used for both diagnosis and treatment of a potentially painful joint.
Operative Treatment: A surgeon is likely to consider a surgical treatment of cervical degenerative problem if one or more following criteria re met:Nonoperative treatments have been failed.
  • The disorder is causing spinal cord dysfunction.
  • The disorder is causing prolonged arm pain or weakness.
The surgical procedure for these patients is removing the bone spur and possible fusion of two or more cervical vertebrae. In most instances, the preferred approach is an anterior interbody fusion. Using the anterior approach, a surgeon can perform a complete discectomy, and then seek to restore the normal disc space height and normal lordosis by implanting a carefully sculpted graft. A titanium plate may be utilized to improve the rate of fusion and avoid a neck brace.NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.


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