Do not Ignore “Cervical” Problem

Cervical spondylosis, commonly called “Cervical” is a general term for age-related wear and tear affecting the spinal disks in your neck. As the disks dehydrate and shrink, signs of osteoarthritis develop, including bony projections along the edges of bones (bone spurs).
Cervical spondylosis is very common and worsens with age. According to the Cleveland Clinic, the condition is present in more than 90 percent of people aged 60 and older.
Most people experience no symptoms from these problems. When symptoms do occur, nonsurgical treatments often are effective.

Spondylosis: What it actually means?
What is the structure of my neck?
Why my neck aches?
What are the risk factors?
What are the signs and symptoms for cervical?
When should I call the doctor?
Doctor Examination
What are the treatment options?
Can it be treated at home?
Are there ways to prevent cervical spondylosis from occurring?

Spondylosis: What it actually means?

Spondylosis is a broad term that simply refers to some type of degeneration in the spine. Most often, the term spondylosis is used to describe osteoarthritis of the spine, but it is also commonly used to describe any manner of spinal degeneration, regardless of what is causing the pain or where the degeneration is occurring.

What is the structure of my neck?

1. Bones

Your spine is made up of 24 bones, called vertebrae, that are stacked on top of one another. These bones connect to create a canal that protects the spinal cord.

The seven small vertebrae that begin at the base of the skull and form the neck comprise the cervical spine.

2. Spinal cord and nerves

These “electrical” cables travel through the spinal canal carrying messages between your brain and muscles. Nerve roots branch out from the spinal cord through openings in the vertebrae (foramen)

3. Intervertebral disks.

In between your vertebrae are flexible “jelly-filled, cushy doughnuts” intervertebral disks. They act as shock absorbers when you walk or run.

Intervertebral disks are flat and round and about a half inch thick. They are made up of two components:

Annulus fibrosus. This is the tough, flexible outer ring of the disk.
Nucleus pulposus. This is the soft, jelly-like center of the disk.

4. Joints

There are three joints between each pair of vertebrae.

The front joint is called the intervertebral disk.
Two joints in the back of the spine are called facet joints.

Within every joint is cartilage, which cushions the ends of bones.

Ligaments are soft bands of tissue that connect the vertebrae together.

Spondylosis is the natural wearing down of these parts of the spine. Cartilage wears out over time, disks lose their volume and become dried and cracked, ligaments may thicken and bone spurs may form where bones rub against each other in areas that are no longer covered with cartilage. All of these changes are defined as spondylosis.

Why my neck aches?

As you age, the bones and cartilage that make up your backbone and neck gradually develop wear and tear (degenerative changes). These changes are normal and they occur in everyone. In fact, nearly half of all people middle-aged and older have worn disks that do not cause painful symptoms. These changes can include:

Dehydrated disks. Disks act like cushions between the vertebrae of your spine. By the age of 40, most people’s spinal disks begin drying out and shrinking resulting in loss of disk height, which allows more bone-on-bone contact between the vertebrae.
Herniated disks. Age also affects the exterior of your spinal disks. Cracks often appear, leading to bulging (herniated) disks — which sometimes can press on the spinal cord and nerve roots.
Bone spurs. Disk degeneration often results in the spine producing extra amounts of bone in a misguided effort to strengthen the spine. These bone spurs can sometimes result in the narrowing of space pinch the spinal cord and nerve roots.
Facet joint arthritis. 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.
Stiff ligaments. Ligaments are cords of tissue that connect bone to bone. Spinal ligaments can stiffen with age, making your neck less flexible.

What are the risk factors?

Cervical spondylosis is a normal part of aging. It is the most common risk factor for cervical spondylosis. The condition is extremely common in patients who are middle-aged and older.
Occupation. Jobs that involve repetitive neck motions, awkward positioning, or a lot of overhead work put extra stress on your neck. Construction workers because they do the heavy lifting. Bus or truck drivers as they are exposed to a lot of vibrations.
Neck injuries. Previous neck injuries appear to increase the risk of cervical spondylosis.
Genetic factors. Some individuals in certain families will experience more of these changes over time, while others will not. A family history of neck pain and spondylosis may be present.
Smoking has been linked to increased neck pain.
Depression or anxiety
Being overweight and inactive

What are the signs and symptoms for cervical?

For most people, cervical spondylosis causes no symptoms. When symptoms do occur, they typically include pain and stiffness in the neck. This pain can range from mild to severe and may develop gradually or occur suddenly. It is sometimes worsened by looking up or looking down for a long time, or by activities in which the neck is held in the same position for a prolonged period of time—such as driving or reading a book. The pain usually improves with rest or lying down.

Other symptoms may include:

Headaches
Grinding or popping noise or sensation when you turn your neck
Muscle spasms in the neck and shoulders

Sometimes, 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 (cervical myelopathy) or nerve roots (cervical radiculopathy) become pinched, you might experience:

Tingling, numbness and weakness in your arms, hands, legs or feet
Lack of coordination and difficulty walking
Loss of bladder or bowel control
Loss of function of hands, like having problems in writing

When should I call the healthcare provider?

Most cases of neck pain go away on their own or with nonsurgical treatments. If neck pain or discomfort lasts more than a few days, reach out to your healthcare provider for guidance.

Seek immediate medical care if you have:

Severe pain or pain that is worsening.
Numbness or tingling in arms.
Trouble with coordination, trouble walking.
Muscle weakness or heaviness in arms or legs.
Loss of bladder or bowel control.
Dizziness or blackouts when turning the head or bending the neck. This can suggest that the vertebral artery which supplies the brain is being nipped by the degenerative changes in the spine.

Doctor Examination

Physical Examination

After discussing your medical history and general health, your doctor will conduct a thorough examination of your neck, shoulders, arms and, frequently, your legs. He or she will conduct a number of tests, looking for problems or changes in:

Strength—in your arms, hands, and fingers
Touch sensation
Reflexes
Blood flow
Flexibility—in your neck and arms
Gait (the way you walk)

Your doctor may also gently press on your neck and shoulders—feeling for trigger (tender) points or swollen glands. He or she will also ask questions to understand more about your symptoms and any injuries that may have occurred to your 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?

2. Tests

Your doctor may order diagnostic tests to help 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 your neck. It can also reveal degenerative changes in your 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 determine whether your 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 your doctor better view your spinal canal and any bone spurs.

Other tests.

In some cases, your doctor may order a blood test to determine whether a rheumatoid factor—or any other antibody indicative of inflammatory arthritis–is present.

What are the treatment options?

Treatments for cervical spondylosis focus on providing pain relief, lowering the risk of permanent damage, and helping you lead a normal life. Nonsurgical methods are usually very effective.

A. Nonsurgical Treatment

In most cases, treatment for cervical spondylosis is nonsurgical. Nonsurgical treatment options include:

1. Physical therapy.

Physical therapy is usually the first nonsurgical treatment that your doctor will recommend. Specific exercises can help relieve pain, as well as strengthen and stretch weakened or strained muscles. In some cases, physical therapy may include posture therapy or the use of traction to gently stretch the joints and muscles of your neck. Physical therapy programs vary in length, but generally last from 6 to 8 weeks. Typically, sessions are scheduled 2 to 3 times per week.

2. Exercises.

A person can ease the symptoms of cervical spondylosis with a few simple neck exercises. These exercises can help to moderate the impact of the condition and alleviate pain or feelings of stiffness. However, they will not cure cervical spondylosis.

3. Medications.

During the first phase of treatment, your doctor may prescribe several medications to be used together to address both pain and inflammation.

Acetaminophen. Mild pain is often relieved with acetaminophen.
Nonsteroidal anti-inflammatory drugs (NSAIDs). Often prescribed with acetaminophen, NSAIDs such as ibuprofen and naproxen are considered first-line medications for neck pain. They relieve both pain and swelling and may be prescribed for a number of weeks, depending on your specific symptoms. Other types of pain medication can be considered if you have serious contraindications to NSAIDs or if your pain is not well controlled.
Oral corticosteroids. A short course of oral corticosteroids can help relieve pain by reducing inflammation.
Muscle relaxants. Medications such as cyclobenzaprine or carisoprodol can be used to treat painful muscle spasms.
A low-dose tricyclic antidepressant, such as amitriptyline, is sometimes used for persistent (chronic) neck pain. The dose of amitriptyline used for pain is 10-30 mg at night. At higher doses, tricyclic antidepressants are used to treat depression. However, at lower doses they have been found to help relieve certain types of pain, including neck pain.

4. Soft cervical collar.

This is a padded ring that wraps around the neck and is held in place with velcro. Your doctor may advise you to wear a soft cervical collar to limit neck motion and allow the muscles in your neck to rest. A soft collar should only be worn for a short period of time since long-term wear may decrease the strength of the muscles in your neck.

5. Ice, heat, and other modalities.

Your doctor may recommend careful use of ice, heat, massage, and other local therapies to help relieve symptoms.

6. Steroid Based Injection.

Many patients find short-term pain relief from steroid injections. Although less invasive than surgery, steroid-based injections are prescribed only after a complete evaluation by your doctor. Your doctor will talk with you about the risks and benefits of steroid-based injections for your specific condition.

The most common procedures for neck pain include:

a) 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.”

b) Cervical facet joint block.

In this procedure, steroid and anesthetic medicine is injected into the capsule of the facet joint. 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.

c) Medial branch block and radiofrequency ablation.

This procedure is used in some cases of chronic neck pain. It can be used to both diagnose and treat a painful joint. During the diagnosis portion of the procedure, the nerve that supplies the facet joint is blocked with a local anesthetic. If your pain is relieved, then your doctor may have pinpointed the source of your neck pain. The next step option may be to block the pain more permanently. This is done by damaging the nerves that supply the joint with a “burning” technique—a procedure called radiofrequency ablation. Pain relief from an ablation typically lasts for several months. If the nerve regenerates, however, pain can return.

B. Surgical Treatment

Surgery is not commonly recommended for cervical spondylosis and neck pain unless your doctor determines that:

A spinal nerve is being pinched by a herniated disk or bone (cervical radiculopathy), or
Your spinal cord is being compressed (cervical spondylotic myelopathy)

Patients who have progressive neurologic symptoms, such as arm weakness, numbness, unsteadiness while walking, or falling, are more likely to be helped by surgery.

Sometimes, surgery may be recommended if you have severe neck pain (without nerve compression) that has not been relieved by nonsurgical treatment. However, some patients with severe neck pain will not be candidates for surgery. This may be due to the widespread nature of their arthritis, other medical problems, or other causes for their pain, such as fibromyalgia.

Can it be treated at home?

If your condition is mild, you can try a few things at home to treat it:

Take an OTC pain reliever, such as acetaminophen (Tylenol) or an NSAID, which includes ibuprofen (Advil) and naproxen sodium (Aleve).
Use a heating pad or a cold pack on your neck to provide pain relief for sore muscles.
Exercise regularly to help you recover faster.
Wear a soft neck brace or soft collar to get temporary relief. However, you shouldn’t wear a neck brace or collar for long periods of time because that can make your muscles weaker.
A firm supporting pillow seems to help some people when sleeping. Try not to use more than one pillow.

Are there ways to prevent cervical spondylosis from occurring?

There is no way to prevent cervical spondylosis as this condition is a normal, age-related deterioration (“wear and tear”) of the joint space and disks in your neck.

If you do have a job or a hobby that results in a lot of time spent looking overhead, downward or having your head in an awkward posture, take many short breaks in your day (if possible). Learn proper stretching and strengthening exercises from your healthcare provider or physical therapist.

Follow other self-help therapies such as applying ice or heat to your neck to ease muscle soreness and pain and taking over-the-counter anti-inflammatory drugs and pain-killers such as ibuprofen or naproxen.

Always follow the instructions of your healthcare professionals and physical therapist.

Outlook for cervical spondylosis

Cervical spondylosis is a common, and often age-related, condition that can cause stiffness, discomfort, and headaches related to neck pain.

Your doctor may not be able to reverse the condition, but they can often recommend conservative treatments to help you overcome the discomfort and pain