Treatment of Cervical Spondylosis (Arthritis of the Neck) with physiotherapy, steroid injection and surgeon

Dr. Moradi, a neurologist

Neck pain can be caused by many things—but is most often related to getting older. Like the rest of the body, the disks and joints in the neck (cervical spine) slowly degenerate as we age. Cervical spondylosis, commonly called arthritis of the neck, is the medical term for these age-related, wear-and-tear changes that occur over time.  In most cases, cervical spondylosis responds well to conservative treatment that includes medication and physical therapy.

Anatomy

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. Other parts of your spine include:

    • 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).
    • Intervertebral disks:In between your vertebrae are flexible 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.

    What causes cervical spondylosis?

    • Degeneration: The spinal discs in the neck may slowly wear away (degenerate). With time, the discs become thinner, and the soft tissue has less elasticity.
    • Herniation: Normal aging can cause part of a spinal disc to break or crack. Doctors call this a herniated disc. The herniation can allow the disc to bulge out, pressing on nearby tissue or a spinal nerve. This pressure can cause pain, tingling, or numbness.
    • Osteoarthritis: Osteoarthritis is a progressive condition that causes cartilage in joints to degenerate. With osteoarthritis, cartilage degenerates faster than with normal aging.
    • Bone spurs: When cartilage in the spine starts to degenerate, abnormal bone growths may grow along the edges of vertebrae. These growths (called osteophytes or bone spurs) are common as people get older. Often, they cause no symptoms.

     

    Risk Factors for Cervical Spondylosis

    • Aging is the major factor for developing cervical osteoarthritis (cervical spondylosis). In most people older than age 50, the discs between the vertebrae become less spongy and provide less of a cushion. Bones and ligaments get thicker, encroaching on the space of the spinal canal. Cervical spondylosis is a normal part of aging. Spinal disks tend to dehydrate and shrink with the passing years.
    • a previous injury to the neck. People in certain occupations or who perform specific activities — such as gymnasts or other athletes — may put more stress on their necks.
    • Poor posture might also play a role in the development of spinal changes that result in cervical spondylosis.
    • Occupation. Certain jobs may place extra stress on your neck. This may include repetitive neck motions, awkward positioning or a lot of overhead work.
    • Genetic factors. Some families will have more of these changes over time, while other families will develop less.

    Cervical spondylosis symptoms 

  • Many people with cervical spondylosis don’t even know it. It’s common to have no symptoms related to this condition. If you do experience symptoms related to cervical spondylosis, neck pain or stiffness may be the main sign. Pain may get worse when you move your neck. Other cervical spondylosis symptoms include:

    • A nagging soreness in the neck
    • Neck stiffness or spasms
    • A clicking or popping sound when you move your neck
    • Dizziness

    As the vertebral discs wear away with time, the spinal cord (and the nerves around it) can be put under increased pressure. This compression can result in worsening neck pain and other symptoms. Doctors call this condition cervical spondylotic myelopathy (CSM).

    Preparing for your appointment

  • What you can do 

    Before your appointment, you might want to write a list of answers to the following questions:

    • When did your signs and symptoms begin?
    • Does any type of movement or positioning make them better or worse?
    • Do you know if your parents or siblings experienced neck problems?
    • Have you ever had whiplash or any other neck injury?
    • Do you have other health conditions?
    • What medications or supplements do you regularly take?

    What to expect from the doctor 

  • A doctor who sees you for neck pain may ask:
    • Where exactly does your neck hurt?
    • Have you had previous episodes of similar pain that eventually went away?
    • Do your symptoms include any changes in your bladder or bowel control?
    • Do your symptoms include any tingling or weakness in your arms, hands, legs or feet?
    • Do your symptoms include difficulty walking?
    • What treatments or self-care measures have you tried so far?
    • Have any treatments or self-care measures helped?
    • What is your occupation?
    • What are your hobbies and recreational activities?

    Diagnose cervical spondylosis 

  •  

  • physical exam 

    Your doctor will perform a physical exam to find the cause of your neck pain or other symptoms. Your symptoms and their severity give doctors clues to how much pressure your cervical spine might be under. During a physical exam, a doctor may check your:

    • Neck flexibility
    • Muscle strength and reflexes in your hands, arms, or legs
    • Walking function

    Imaging test

    Sometimes, doctors can diagnose cervical spondylosis with just a physical exam. Other times, they may recommend tests to learn more about what may be causing your symptoms. These tests may include the following:

     

    • X-rays show the bones in your spine. Not all bone abnormalities cause symptoms. Doctors may use X-rays as a starting point. X-rays or other tests can also help doctors rule out other causes of your discomfort, such as a spine tumor.
    • MRI images show the details of soft tissues such as cartilage and nerve roots. This test can show spinal compression more clearly than X-rays. An MRI can help doctors identify the source and location of pain.
    • Other tests may include a myelogram (type of CT scan) or electromyography (nerve function test). These tests give doctors more details on how cervical spondylosis may be affecting your nerves.

    Treatment

  • Nonsurgical Treatment 

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

    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.

    Medications 

  •  During the first phase of treatment, your doctor may prescribe several medications to be used together to address both pain and inflammation.
    • 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.
    • Muscle relaxants.Medications such as cyclobenzaprine or carisoprodol can be used to treat painful muscle spasms.

    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.

    Ice, heat, and other modalities

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

    Steroid-based injections

  • Many patients find short-term pain relief from steroid injections. The most common procedures for neck pain include:
    • 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."
    • 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.
    • 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.

    Surgery Cervical Spondylosis 

  • Cervical spondylosis tends to be a chronic (long-term) condition. But in most cases, it is not progressive. Surgery is required only in rare cases. The goal of surgery is to remove the source of pressure on the spinal cord and nerves. The surgery may also include adding stabilization in the form of implants or through fusion of the vertebrae. But surgery is considered only when there is a severe loss of function. For instance, it might be considered if you had a progressive loss of feeling and function in your arms, legs, feet, or fingers. Any type of spinal cord compression could result in permanent functional disability. The surgeon can approach the cervical spine from the front (anterior) or the back (posterior). Approaching from the front might be used to remove the discs and spurs that are causing pressure. The disc may be replaced with an implant. A more extensive surgery calls for the removal of both discs and parts of the vertebra. These parts are replaced with a bone graft or implant. Approaching from the back would be used to perform either a laminectomy or a laminoplasty. In a laminectomy, the rear parts of the vertebrae in the neck -- the lamina and spinous processes -- are removed. In a laminoplasty, the vertebra is left in place, but is cut free along one side. Both procedures relieve pressure on the spinal cord or nerves. As with any surgery, there is risk of infection or complications with anesthesia. Surgery is usually followed by a rehabilitation program.