Cervical spondylosis

• cervical spondylosis is a very common disorder in the second half of life and results from degenerative, osteoarthritic change in the cervical spine
• more than half of the population over 50 years are affected, of whom 20% have symptoms
• onset is usually insidious. Relatively few require operative treatment
• cervical spondylosis on an x-ray report refers to the radiographic changes associated with the degenerative process affecting the discs and the facet joints of the cervical spine
• as in lumbar disc degeneration, the radiographic changes and symptoms suffered correlate poorly
  • most individuals will have some radiographic evidence of spondylosis from the age of about 35 years
• it is well recognised that, though poorly understood why, previously asymptomatic individuals develop persistent spondylotic neck pain following a traumatic event, such as a whiplash injury, especially when radiographs confirm spondylotic changes which must have preceded the injury
• as cervical degeneration progresses, the situation is complicated by hypertrophic facet joint changes, i.e. osteophytosis, and disc herniations - these facet joint changes may encroach upon nerve roots as they exit the spine in the exit foramina
  • may cause nerve root symptoms and potentially signs
  • cervical spine instability is relatively rare in purely degenerative spondylosis - however it is more common in inflammatory conditions which have the potential to affect the soft tissues of the neck, e.g. rheumatoid and psoriatic arthritis
  • in primary degenerative cervical disease, secondary neurological morbidity may arise and involve the nerve roots (radiculopathy), the spinal cord (myelopathy) or, less commonly, the vertebral arteries
    • compressive and/or ischaemic cervical myelopathy (due to local architectural and biomechanical disturbances resulting from the spondylotic process) is the commonest cause of spinal cord disturbance in the elderly

Reference

1. Kelly JC, Groarke PJ, Butler JS, Poynton AR, O'Byrne JM. The natural history and clinical syndromes of degenerative cervical spondylosis. Adv Orthop. 2012;2012:393642.