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. ARC. Rheumatic Disease In Practice January 2002.