CERVICAL SPONDYLOSIS

Cervical osteoarthritis is also known as cervical spondylosis. It is a medical condition which involves c

Cervical osteoarthritis is also known as cervical spondylosis. It is a medical condition which involves changes in the joints of neck, bones and discs. This is generally caused due to the deterioration of the muscles owing to old age. With age, the cervical spine breaks down and loses all its fluids. This leads to stiffness in the spine. It occurs usually in middle aged and old aged people. This causes stiffness and severe neck pain. Corrective surgery is helpful to cure Cervical Osteoarthritis.

SYMPTOMS

Cervical Spondylosis results in a narrowing of the space needed by the spinal cord and the nerve roots that pass through the spine to the rest of your body. If the spinal cord or nerve roots become pinched then the person may experience 
● Tingling, numbness and weakness in the arms, hands, legs or feet
● Lack of coordination and difficulty in walking
● Loss of bladder or bowel control
● Headaches
● Muscle spasms in the neck and shoulders.

CAUSES

Cervical spondylosis arises from degenerative changes that occur in the spine as we age. These changes are normal and they occur in everyone. In fact, nearly half of all people middle-aged and older have worn disc that do not cause painful symptoms. 

Disc Degeneration and Bone Spurs 

As we age the spine lose height and begin to bulge. They also lose water content, begin to dry out and weaken. This problem causes settling, or collapse, of the disk spaces and loss of disk space height. Eventually, the cushioning qualities of the disks begin to decrease.

As the facet joints experience increased pressure, they also begin to degenerate and develop arthritis, similar to what may occur in the hip or knee joint. The smooth, slippery articular 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, our body may respond by growing new bone in our facet joints to help support the vertebrae. Over time, this bone overgrowth called bone spurs .This may narrow the space for the nerves and spinal cord to pass through also called STENOSIS.

EXAMINATION

Physical Examination

After discussing the medical history and general health, doctor will conduct a thorough examination of your neck, shoulders, arms and frequently legs.

● Strength—in your arms, hands, and fingers
● Touch sensation
● Reflexes
● Blood flow
● Flexibility—in neck and arms
● Gait (the way patient walk)
The doctor may also gently press neck and shoulder for trigger (tender) points or swollen glands. Doctor may also ask questions to understand more about the symptoms and any injuries that may have occurred to neck. These questions may include:
● When did the pain start?
● When does the pain occur? Is it continuous or does it come and go?

● Do certain activities make the pain worse?

● Have you ever had pain before?
● Have you ever been treated for pain?
● Do you have any weakness or numbness in your arms or legs?
● Do you have difficulty with fine motor skills, such as
handwriting or buttoning your shirt?
● Do you have loss of balance or other coordination problems?
● Were you ever involved in an accident or had an injury to
your neck?

Tests

Doctor may ask for diagnostic tests to help or confirm the diagnosis of cervical spondylosis . These tests may include: 
X-rays: These provide images of dense structures, such as bone. An x- ray will show the alignment of the bones along neck. It can also reveal degenerative changes in cervical spine—such as the loss of disk height or the presence of bone spurs. 

Magnetic resonance imaging (MRI) scans: These studies create better images of the body’s soft tissues, such as muscles, disks, nerves, and the spinal cord. An MRI can help to determine whether symptoms are caused by damage to soft tissues—such as a bulging or herniated disk.
Computerized tomography (CT) scans: More detailed than a plain x- ray, a CT scan can help doctor better view of spinal canal and any bone spurs.

TREATMENT

Treatments for cervical spondylosis focus on providing pain relief,
lowering the risk of permanent damage, and helping to lead a normal
life.

MEDICAL TREATMENT

● muscle relaxants, such as cyclobenzaprine (Fexmid), to treat muscle spasms
● steroid injections, such as prednisone, to reduce tissue inflammation and subsequently lessen pain
● prescription nonsteroidal anti-inflammatory drugs (NSAIDs), such as diclofenac (Voltaren-XR), to reduce inflammation PHYSICAL TREATMENT
● There is little evidence for using exercise alone or mobilisation or manipulations alone.
● Mobilisation or manipulations in combination with exercises are effective for pain reduction and improvement in daily functioning in sub-acute or chronic mechanical neck pain with or without headache.
● There is moderate evidence that various exercise regimens, like proprioceptive, strengthening, endurance, or coordination exercises are more effective than usual pharmaceutical care.
● Immobilization of the cervical spine is the mainstay of conservative treatment for patients with severe cervical spondylosis with evidence of myelopathy
● . Immobilization limits the motion of the neck, thereby reducing nerve irritation.

● Soft cervical collars are recommended for daytime use only, but they are unable to appreciably limit the motion of the cervical spine.
● A program of isometric cervical exercises may help to limit the loss of muscle tone that results from the use of more restrictive orthoses.
● Mechanical traction is a widely used technique. This form of treatment may be useful because it promotes immobilization of the cervical region and widens the foraminal openings.
● Physical modalities such as cervical traction, heat, cold, therapeutic ultrasound, massage, and transcutaneous electrical nerve stimulator (TENS) lacked sufficient evidence regarding their efficacy in the treatment of acute or chronic neck pain. 
● In patients experiencing radicular pain, cervical traction may be incorporated to alleviate the nerve root compression that occurs with foraminal stenosis.
● Trigger point injections can be employed to treat myofascial trigger points, which can clinically manifest as neck, shoulder, and upper arm pain.
● Clinical dry needling, cupping therapy also help

Home Exercises include cervical retraction, cervical extension, deep cervical flexor strengthening, scapular strengthening, stretching of the chest muscles via isometric contraction of flexor of extensor muscles to encourage the mobility of the neural structures of the upper extremity.
Education The natural history of cervical spondylitis is highly variable, as well as challenging to prevent its adverse effects. The patient should receive training on ways to delay early onset of cervical spondylitis, including maintaining good neck strength and flexibility, leading an active and healthy lifestyle. Thus preventing neck injuries (e.g., good ergonomics, avoiding prolonged neck extension, proper equipment for contact sports, safe tackling technique, and seatbelt use in automobiles).