Cervical Spondylosis

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Original Editors - Gertjan Peeters

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Search Strategy[edit | edit source]

First I’ve used Pubmed and PEDro, where I combined various terms – such as: cervical spondylosis, cervical disc degeneration, physical therapy, physiotherapy, treatment, … – to search articles on this topic. Through this way I’ve found some studies and reviews. Unfortunately the most of this studies and reviews are quite old. Therefore I decided to search more information about this topic in the medical library of the VUB and in another library. After a while I found some books with primarily medical information about this subject and some books about the physiotherapeutic options.

Definition/Description [1] [2] [3] [4] [5][edit | edit source]

Cervical Spondylosis is a degenerative disorder at the level of the cervical spine. It can be described as the result of degeneration of the intervertebral discs or the corpus vertebrae in the cervical region. Possible characteristics are Degenerative_Disc_Disease, the formation of osteophytes, facet and uncovertebral joint arthritis, ossification of the posterior longitudinal ligament, hypertrophy of the ligamentum flavum, spinal stenosis. In some cases this degeneration also leads to a posterior protrusion of the annulus fibers of the intervertebral disc. This protrusion can cause compression of nerve roots, which in turn can lead to pain, motor disturbances such as muscle weakness, and sensory disturbances. As the spondylosis progresses there may be even interference with the blood supply to the spinal cord where the vertebral canal is narrowest.

Clinically Relevant Anatomy[edit | edit source]

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Epidemiology /Etiology[edit | edit source]

Various sources report that the sixth and seventh nerve roots are the most commonly involved nerve roots. This means that cervical spondylosis mainly affects C5-C6 and C6-C7. A 1992 study[6] showed that spondylotic changes are most common in persons older than 40 years. Another conclusion of this study is that more than 70% of men and women are affected. And using radiographic evaluation it was also found that these changes are more severe in men than in women. Other studies report that cervical spondylosis may affect males earlier than females, but this studies report also that this is not true in all studied populations.

Characteristics/Clinical Presentation[edit | edit source]

Pain, paresthesias or muscle weakness, or a combination of these symptoms are the most common symptoms in patients with cervical spondylosis. A 1996 study[5] report that intermittent neck and shoulder pain is the most common syndrome seen in clinical practice. Another study[7] showed that, due to cervical radiculopathy, the pain most often occurs in the cervical region, the upper limb, shoulder, and/or interscapular region. In some cases the pain may be atypical and manifest as chest pain or breast pain. This study also reports that the pain is most frequently present in the upper limbs and the neck. Another study[8] showed that also chronic suboccipital headache could be a clinical syndrome in patients with cervical spondylosis. This headache may radiate to the base of the neck and the vertex of the skull. Also central cord syndrome is a syndrome that may be seen in relation to cervical spondylosis. 2 studies[9][10] demonstrate that in some cases dysphagia or airway dysfunction has been reported to cervical spondylosis. Various studies[4][6][8] report that cervical spondylosis often causes cervical spondylotic myelopathy.

Differential Diagnosis[11][edit | edit source]

  • Other non-specific neck pain lesions - acute neck strain, postural neck ache or whiplash,
  • Fibromyalgia and psychogenic neck pain
  • Mechanical lesions - disc prolaps or diffuse idiopathic skeletal hyperostosis
  • Inflammatory disease - rheumatoid arthritis, ankylosing spondylitis or polymyalgia rheumatica,
  • Metabolic diseases - Paget's disease, osteoporosis, gout or pseudo-gout
  • Infections - osteomyelitis or tuberculosis
  • Malignancy - primary tumours, secundary deposits or myeloma


Diagnostic Procedures[edit | edit source]

Most of the time cervical spondylosis is diagnosed on clinical signs and symptoms alone.

Signs:

  • poorly localised tenderness,
  • limited range of motion,
  • minor neurological changes.

Symptoms:

  • cervical pain aggravated by movement,
  • referred pain,
  • retro-orbital or temporal pain,
  • cervical stiffness,
  • vague numbness, tingling or weakness in upper limbs,
  • dizzyness or vertigo,
  • poor balance.

Outcome Measures[edit | edit source]

add links to outcome measures here (also see Outcome Measures Database)

Examination[edit | edit source]

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Medical Management[2] [3]
[edit | edit source]

The most commonly used medical treatment in patients with cervical spondylosis is a conservative treatment. This includes pharmacological treatments (NSAID’s, opioids, …), lifestyle modifications (neck schools, ergonomics, workplace modifications, …) and physical therapy (see next chapter: “Physical Therapy Management”). There isn’t enough evidence for neck immobilisation: various sources contradict each other.

Physical Therapy Management
[edit | edit source]

3 Recent reviews[12][13][14] reach similar conclusions. First they conclude that there is little evidence for using exercises alone or mobilization and/or manipulations alone as physical treatment. Then they also conclude that mobilization and/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. When they compare mobilization with manipulations, they concluded that there is no difference between both. The end conclusion of these reviews is that there is only for multimodal treatment (manual therapy in combination with exercises and education) enough evidence. Another study[15] reported that cervical traction leads to symptomatic relief in 81% of the patients with cervical spondylosis.

A 2011 study[16] on the effects of three different conservative treatments (active + passive physiotherapy methods, active treatment methods and medication-therapy) on pain, disability, quality of life, and mood in patients with cervical spondylosis reports that there was more improvement in the two groups receiving exercise treatment than the group receiving medical treatment, especially during long-term follow up.

Key Research[edit | edit source]

add links and reviews of high quality evidence here (case studies should be added on new pages using the case study template)

Resources
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Clinical Bottom Line[edit | edit source]

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Recent Related Research (from Pubmed)[edit | edit source]

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References[edit | edit source]

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  1. ↑ MacSween R.N.M., Whaley K., Muir’s textbook of pathology – thirteenth edition, Edward Arnold, Great Britain, 1992, p. 853-854.
  2. ↑ 2.0 2.1 Benatar M., Neuromuscular Disease - Evidence and Analysis in Clinical Neurology, Humana Press Inc., Totowa, NJ, 2006, p. 61-78.
  3. ↑ 3.0 3.1 Macnab I. Cervical spondylosis. Clin Orthop Relat Res. 1975;(109):69-77.
  4. ↑ 4.0 4.1 Emery SE. Cervical spondylotic myelopathy: diagnosis and treatment. J Am Acad Orthop Surg. Nov-Dec 2001;9(6):376-88.
  5. ↑ 5.0 5.1 McCormack BM, Weinstein PR. Cervical spondylosis. An update. West J Med. Jul-Aug 1996;165(1-2):43-51.
  6. ↑ 6.0 6.1 Rahim KA, Stambough JL. Radiographic evaluation of the degenerative cervical spine. Orthop Clin North Am. Jul 1992;23(3):395-403.
  7. ↑ Ellenberg MR, Honet JC, Treanor WJ. Cervical radiculopathy. Arch Phys Med Rehabil. Mar 1994;75(3):342-52.
  8. ↑ 8.0 8.1 Heller JG. The syndromes of degenerative cervical disease. Orthop Clin North Am. Jul 1992;23(3):381-94.
  9. ↑ Kaye JJ, Dunn AW. Cervical spondylotic dysphagia. South Med J. May 1977;70(5):613-4.
  10. ↑ Kanbay M, Selcuk H, Yilmaz U. Dysphagia caused by cervical osteophytes: a rare case. J Am Geriatr Soc. Jul 2006;54(7):1147-8.
  11. ↑ Binder AI. Cervical spondylosis and neck pain: clinical review. BMJ 2007:334:527-31
  12. ↑ Gross AR, Hoving JL, Haines TA, Goldsmith CH, Kay T, Aker P, Bronfort G. A Cochrane review of manipulation and mobilization for mechanical neck disorders. Spine (Phila Pa 1976). 2004 Jul 15;29(14):1541-8.
  13. ↑ Bronfort G, Haas M, Evans RL, Bouter LM. Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis. Spine J. 2004 May-Jun;4(3):335-56.
  14. ↑ Hurwitz EL, Carragee EJ, van der Velde G, Carroll LJ, Nordin M, Guzman J, Peloso PM, Holm LW, Côté P, Hogg-Johnson S, Cassidy JD, Haldeman S. Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine (Phila Pa 1976). 2008 Feb 15;33(4 Suppl): S1 23-52.
  15. ↑ Swezey RL, Swezey AM, Warner K. Efficacy of home cervical traction therapy. Am J Phys Med Rehabil. Jan-Feb 1999;78(1):30-2.
  16. ↑ Aslan Telci E, Karaduman A. Effects of three different conservative treatments on pain, disability, quality of life, and mood in patients with cervical spondylosis. Rheumatol Int. 2011 Jan 19.
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