Health Navigation

What is Cervical Spondylosis?
By John Oró, MD

Cervical spondylosis is a degenerative disorder of the cervical spine which results in narrowing of the nerve root and spinal canals and leads to nerve root and spinal cord compression. Factors which affect the development of cervical spondylosis include the size of the spinal canal, aging, gravity or loading, and spinal motion.

The initial change, which begins in our 20's, is a decrease in the water content of the nucleus pulposus, the central portion of the disc. As the disc dehydrates, it decreases in height and has less ability to resist loading and stress. The collagen fibers fragment and the annulus, the outer rim of the disc, bulges into the spinal and nerve root canals. The lowered height and resulting increased mobility increase the stress on the vertebral endplates, which develop spurs, and the facet joints, which hypertrophy and further narrow the nerve root canals. The spinal ligaments thicken, loose their elasticity, and buckle into the spinal canal.

What complaints might I have?

Most persons with cervical spondylosis present with compression of a nerve root, a condition called radiculopathy. Patients usually complain of neck pain and pain radiating into the shoulder, arm or scapula. The pain often radiates in the dermatomal pattern of the nerve involved. Pain may be aggravated by neck extension such as with shaving or when looking up at the upper cabinets. Some people notice paresthesias and weakness in the shoulder, arm, or hand.

About 5% of patients will present with signs of spinal cord compression, called a myelopathy. Complaints include stiffness, heaviness or weakness in legs, cramping, muscle spasms, and easy fatigueability. Symptoms may develop suddenly, often after minor trauma. In others, symptoms may be recurrent, or insidiously or rapidly progressive.

Persons with the myelopathy hand syndrome have difficulty in fine activities such as buttoning clothes or writing. The hands may feel cold or diffusely painful.

Uncommonly, spurs may develop in the vertebral artery canals that run through the cervical spine and compress the vertebral artery. This can result intermittent brain stem ischemia which often improves following surgical decompression of the vertebral artery. Another uncommon presentation is swallowing difficulty caused by a large spur on the front part of the cervical spine which compresses the esophagus.

What might be found on my examination?

Persons with radiculopathy may have weakness, decreased reflex(s), and/or decreased sensation in the arm or hand. Hyperextension with lateral deviation of neck may reproduce the shoulder or arm pain and helps localize the problem to the level of the nerve root.

Persons with myelopathy may have weakness in the arms, hands or legs, spastic gait, and brisk reflexes. Your doctor may find clonus, a Babinski sign or Hoffman's sign. As the myelopathy progresses, marked weakness, atrophy, spasticity, or diminished reflexes develop. Some may notice a shock like sensation down the spine with certain movements.

How can my primary care physician treat my symptoms?

Many persons with radiculopathy will respond to non-surgical treatment over 4-6 weeks. Initial treatment includes rest, nonsteroidal anti-inflammatory medications and analgesics as needed. Persons with significant muscle spasm may benefit from muscle relaxants. If the pain is persistent, physical therapy and/or cervical traction may provide benefit. Home cervical traction is performed in a slightly flexed position. A physical therapist can train you in the proper use of the traction device. For some people, a cervical epidural block or a short course of oral steroids may be of benefit. Referral for cervical rehabilitation overseen by a physiatrist may be needed in others, especially in chronic cases where other musculoskeletal or psychosocial factors play a role.

What if I do not get better?

If you are not improving, your doctor will want to obtain cervical spine x-rays and an MRI scan. These will be evaluated for other causes of pain or neurologic dysfunction such as a tumor or fracture. The lateral film shows the curvature of your spine. Cervical spondylosis may cause a straightening or a reversal of the normal curvature. Arthritic changes and spurs may be seen at the level of the disc. Loss of disc height, spontaneous fusions, and degenerative subluxations can be visualized.

Magnetic resonance imaging (MRI) is the diagnostic study of choice for persons with cervical spondylosis. It allows visualization of the soft tissue structures and can show disc ruptures, spurs, narrowing of the nerve root or spinal canals and compression of the nerves and spinal cord.

MRI scan shows spinal cord compression at three levels in the mid-portion of the cervical spine.

When should I see a neurosurgeon?

If the spondylitic changes on MRI are mild or moderate, and there is no myelopathy or hand weakness, your doctor may wish to continue conservative therapy for 6-12 weeks. If you do not steadily improve during conservative treatment, an evaluation by a neurosurgeon should be considered. If your MRI shows significant compression of the spinal or nerve root canals, or if you have moderate to severe weakness, bowel or bladder problems, or spasticity, you should be referred to a neurosurgeon.

What surgical treatments are available for cervical spondylosis?

Surgical treatment is reserved for those persons with intractable pain, recurrent neck pain, significant weakness, or myelopathy. Surgical procedures for single level disease include anterior cervical discectomy with or without fusion or a posterior cervical laminotomy. For disease involving multiple levels, your neurosurgeon may recommend multiple anterior cervical discectomies and fusions, multiple subtotal vertebrectomies and fusions, or multiple posterior cervical laminectomies or laminoplasties.

You should discuss the possible benefits and risks of surgery with your neurosurgeon. In many cases, you can get further insight by having the neurosurgeon review some of the key x-ray and MRI images with you. Ask questions. The more you know, the more aware you will be about your problem and your options.