Cervical spondylosis

Cervical spondylosis is the medical term for neck pain caused by age-related ‘wear and tear to bones and tissues.

The most common symptoms of cervical spondylosis are neck pain, stiffness and headaches. More rarely, it can trap nerves in your neck, causing numbness and tingling in your hands.

Cervical spondylosis is very common and worsens with age. More than 85% of people older than age 60 are affected by cervical spondylosis.

1 in 10 people can go on to develop long-term (chronic) neck pain.

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What causes cervical spondylosis?

As people get older, the effects of ageing and everyday use cause wear to the joints and tissues that make up the spine. These changes include:

  • Dehydrated discs. Discs act like cushions between the vertebrae of the spine. As we age, most people's spinal discs begin to dry out and shrink. As the discs become smaller, there is more bone-on-bone contact between the vertebrae.

  • Bone spurs. As the discs break down, the body may produce extra amounts of bone in a misguided effort to strengthen the spine. These bone spurs can sometimes pinch the spinal cord and nerve roots.

  • Stiff ligaments. Ligaments are cords of tissue that connect bone to bone. Spinal ligaments can stiffen with age, making the neck less flexible.

Symptoms of cervical spondylosis

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. It is sometimes worsened by looking up or down for a long time, or activities in which the neck is held in the same position for a prolonged period. The pain usually improves with rest or lying down.

Other symptoms include headaches and muscle spasms in the neck and shoulders.

In severe cases, cervical spondylosis will result in entrapping the nerves. If this occurs, your symptoms may include numbness and weakness in the arms, hands, and fingers.

When should I seek medical help?

There are circumstances when neck pain might be caused or accompanied by serious issues. If such symptoms are present it’s best to seek immediate medical attention to avoid further complications:

  • Pain or stiffness does not go away after a few weeks

  • The pain is disturbing your sleep

  • Painkillers do not work

  • Your pain was caused by a major accident such as a traffic collision or a fall

  • Weakness, numbness, or tingling in your limbs

  • Previous history of cancer

  • If you have a fever, chills, or unexplained weight loss

Diagnosis

Cervical spondylosis is usually suspected if there are typical symptoms of neck pain and stiffness. During the consultation, your doctor will ask about your pain symptoms and your past medical history. Then they will perform a physical examination, including palpating the area of pain and checking the range of motion of your neck.

Cervical spondylosis can limit the range of movement in your neck. You will be asked to rotate your head from side to side and tilt your head towards your shoulders.

They may also test the reflexes in your hands and feet, and check that you have full sensation in all your limbs. Problems with your reflexes or a lack of sensation could indicate nerve damage.

You may be referred for an X-ray, which will show characteristic features of spondylosis, such as the presence of osteophytes (lumps of extra bone).

If the medical history and/or physical exam suggest that your nerve is trapped or something more serious is causing any of the symptoms, more advanced diagnostic testing may be needed.

Treatment

Treatment for cervical spondylosis aims to relieve symptoms of pain and prevent permanent damage to your nerves.

First-line treatments include:

  • Doing low-impact aerobic exercises such as swimming or walking

  • Using one firm pillow at night to reduce strain on your neck

  • Correcting your posture when standing and sitting

  • Over-the-counter painkillers such as Panadol and NSAIDs (Non-steroidal anti-inflammatory drugs)

If pain persists, your doctor may recommend:

  • Facet joint injections (with local anaesthetic and steroids)

  • Nerve block injections (heat is used to temporarily destroy part of sensory nerve, which causes reduction of pain sensation)

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.

Prevention of Cervical spondylosis

You may not be able to prevent cervical spondylosis, but these steps may reduce your risk:

  • Stay physically active.

  • Maintain a healthy weight

  • Use good posture. Adjust your desk, chair and computer so that the monitor is at eye level. Knees should be slightly lower than hips

  • Take frequent breaks. If you travel long distances or work long hours at your computer, get up, move around, and stretch your neck and shoulders.

  • Prevent neck injuries by always using the right equipment and the right form when exercising or playing sports.

  • Avoid trauma to your neck

  • Avoid carrying heavy bags with straps over your shoulder.

  • Sleep in a healthy position

  • If you smoke, quit. Smoking could accelerate the process of cervical disc degeneration