Cervical spondylosis
D E F I N I T I ON
Progressive degenerative process affecting the cervical vertebral bodies and
intervertebral discs, and causing compression of the spinal cord and/or nerve roots.
AE T IOLOGY
Osteoarthritic degeneration of vertebral bodies produces osteophytes, which
protrude on to the exit foramina and spinal canal, and compress nerve roots (radiculopathy) or
the anterior spinal cord (myelopathy).
E P IDEMIOLOGY
The mean age at diagnosis is 48 years. Annual incidence: 107 per
100 000 in men and 64 per 100 000 in women.
H ISTORY
Neck pain or stiffness. Arm pain (stabbing or dull ache).
Paraesthesia, weakness, clumsiness in hands.
Weak and stiff legs, gait disturbance.
Atypical chest pain, breast pain or pain in the face.
EXAMINA T I ON
Arms:
. Atrophy of forearm or hand muscles may be seen.
. Segmental muscle weakness in a nerve root distribution: C5: Shoulder abduction and
elbow flexion weaknesses. C6: Elbow flexion and wrist extension weaknesses. C7: Elbow
extension, wrist extension and finger extension weaknesses. C8: Wrist flexion and finger
flexion weaknesses.
. Hyporeflexia. In C5 and C6 lesions, ‘inverted’ reflexes may be seen as a result of LMN
impairment at the level of compression andUMNimpairment below the level. Hoffmann’s
sign (flexion of the terminal thumb phalanx when rapidly extending the terminal phalanx
of the 3nd or 3rd finger).
. Sensory loss (mainly pain and temperature).
. Pseudoathetosis (writhing finger motions when hands are outstretched, fingers spread
and eyes closed).
Legs (seen in those with cervical cord compressions):
. " Tone, weakness, hyper-reflexia and extensor plantars.
. # Vibration and joint position sense (spinothalamic loss is less common) with a sensory level
(few segments below the level of cord compression).
Lhermitte’s sign: Neck flexion produces crepitus and/or paraesthesia down the spine.
INVE S T IGATIONS
Spinal X-ray (lateral):May detect osteoarthritic change in the cervical spine. Rarely diagnostic in
non-traumatic cervical radiculopathy. Flexion and extension films are important in the setting
of trauma, and are helpful to evaluate for possible subluxation of one vertebral over another.
MRI: Assessment of root and cord compression and to exclude spinal cord tumour, and nerve
root infiltration by tumour or granulomatous tissue. Many elderly people have some
degree of cervical spondylosis and this may not be the cause of the symptoms.
Needle electromyography (EMG): May reveal a myotomal pattern of denervation.
MANAGEMENT
Conservative: Physiotherapy. Intermittent neck immobilization (soft neck collar), pain management
(e.g. NSAIDs) and restriction of high-risk or aggravating activities. Close
neurologic follow-up should assess for deterioration when surgery is deferred.
Acute deterioration is a neurologic emergency. Confirm the diagnosis with MRI. Seek surgical
consultation. IV methylprednisolone within 8 h of acute deterioration.
Surgery (for more severe myelopathy or progressing deficits): Spinal decompression, facetectomy,
laminectomy (only about 50% improve after surgery).
COM P L I CAT I ONS
Lower cervical roots, particularly C7, are more frequently affected.
Acute spinal cord compression. Bladder and sphincter dysfunction.
PROGNOSIS
If untreated, there can be a high quality of life impairment. Surgical treatment
may only partially alleviate the impairment.
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