Cervical Sponylosis

CERVICAL SPONYLOSIS
Cervical spondylosis is a chronic degenerative condition of the

cervical spine that affects the vertebral bodies and intervertebral
disks of the neck (e.g., Disk herniation, spur formation), as well as
the contents of the spinal canal (nerve roots and/or spinal cord).
also include the degenerative changes in the facet joints,
longitudinal ligaments, and ligamentum flavum.
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Pathophysiology
Intervertebral disks lose hydration and elasticity with age, and these losses lead to cracks
and fissures.
The surrounding ligaments also lose their elastic properties and develop spurs.
The disk subsequently collapses as a result of biomechanical incompetence, causing the
annulus to bulge outward.
As the disk space narrows, the annulus bulges, and the facets override.
This change, in turn, increases motion at that spinal segment and
further accelerate the damage to the disk.
Annulus fissures and herniation may occur. Acute disk herniation may complicate chronic
spondylotic changes
➢As the annulus bulges, the cross-sectional area of the canal is narrowed.
➢This effect may be accentuated by hypertrophy of the facet joints (posteriorly) and the
ligamentum flavum, which becomes thick with age.
➢Degeneration of the joint surfaces and ligaments decreases motion and can act as a limiting
mechanism against further deterioration.
➢Thickening and ossification of the posterior longitudinal ligament (PLL) also decreases the
diameter of the canal.
SIGNS AND SYMPTOMS

• Cervical pain
•Chronic suboccipital headache may be present.
Mechanisms include direct nerve compression; degenerative disk, joint, or ligamentous

lesions; and segmental instability.
•Pain can be perceived locally, or it may radiate to the occiput, shoulder, scapula, or arm.
•The pain, worse when the patient is in certain positions, can interfere with sleep.
•Cervical radiculopathy
•Compression of the cervical nerve roots leads to ischemic changes that cause sensory
dysfunction(e.g., Radicular pain) and/or motor dysfunction(e.g., Weakness).
•Radiculopathy most commonly occurs in those aged 40-50 years.
•An acute herniated disk or chronic spondylotic changes can cause cervical radiculopathy.
•The C6 root is most commonly affected because of the predominant degeneration at
the C5-C6 interspace; the next most common sites are at C7 and C5.
•Most cases of cervical radiculopathy resolve with conservative management; few
require surgical intervention.
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•Cervical myelopathy
•Cervical spondylotic myelopathy is the most serious consequence of cervical
intervertebral disk degeneration, especially when it is associated with a narrow
cervical vertebral canal.
•Cervical myelopathy has an insidious onset, which typically become apparent in
those aged 50-60 years.
•Less common manifestations
•Primary sensory loss may be present in a glove-like distribution.
•spinal stenosis is a simultaneous cervical and lumbar stenosis due to spondylosis.
•It is a triad of findings: neurogenic claudication, complex gait abnormality, and a mixed
pattern of upper and lower motor neuron signs.
•Dysphagia may be present if the spurs are large enough to compress the esophagus.
•Vertebrobasilar insufficiency may be observed.
PHYSICAL EXAMINATION
➢The physical examination of axial neck pain includes inspection and palpation of the
patient’s neck.
➢Observe for any muscle spasm or asymmetry. Palpate for any tender points or trigger
points (trigger points are defined as tender points with a referral pain pattern when palpated).
➢Assess the patient’s range of motion(ROM), which may be limited by pain. Also, assess the
patient’s strength of major neck movements (flexion, lateral flexion,
rotation and extension).
• Spurling sign: radicular pain is exacerbated by extension and lateral
bending of the neck toward the side of the lesion, which results in
further foraminal compromise.
• Distal weakness
• Decreased ROM in the cervical spine, especially with neck extension
• Loss of sensation
• Increased reflexes in the lower extremities and in the upper
extremities below the level of the lesion
Causes of cervical spondylosis

• Age
• Cervical spondylosis is a disease observed most commonly in elderly individuals.
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• Among those younger than 40 years, 25% have degenerative disk disease (DDD), and
4% have foraminal stenosis, as confirmed with MRI.
• In those older than 40 years, almost 60% have ddd, and20% have foraminal stenosis,
as confirmed with MRI.
➢ Trauma
• Repetitive subclinical trauma probably influences the onset and rate of progression
of spondylosis.
• ➢Workactivity: cervical spondylosis is significantly higher in patients who carry loads on
their head than in those who do not.
• ➢Genetics: The role of genetics is unclear.
• Patients older than 50 years who had normal cervical spine radiographic findings are
significantly more likely to have a sibling with normal or mildly abnormal radiographic results.
Imaging studies
• Plain cervical radiography is routine in every patient with suspected cervical spondylosis.
• This examination is valuable in evaluating the uncovertebral and facet joints, foramen,
intervertebral disk spaces, and osteophyte formation.
• Myelography, with CT scan, is usually the imaging test of choice to assess spinal and
foraminal stenosis.
➢MRI is a considerable advance in the use of imaging to diagnose cervical spondylosis.
MRI offers the following advantages:

➢Direct imaging in multiple planes
➢Better definition of neural elements
➢Increased accuracy in evaluating intrinsic spinal cord diseases
➢Noninvasiveness
Rehabilitation program
Immobilization of the cervical spine is the mainstay of conservative treatment for patients
with cervical spondylosis.
Immobilization limits the motion of the neck, thereby reducing nerve irritation.
Soft cervical collars are recommended for daytime use only, but they are unable to
appreciably limit the motion of the cervical spine.
More rigid orthoses (e.g., Philadelphia collar) can significantly immobilize the cervical spine.
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Soft and Rigid Collars
Treatment
➢With the use of any of the braces, the patient's tolerance and compliance are
considerations. A program of isometric cervical exercises may help to limit the loss of muscle
tone that results from the use of more restrictive orthoses.
Molded cervical pillows can better align the spine during sleep and provide symptomatic relief
for some patients.
•The use of cervical exercises has been advocated in patients with cervical spondylosis.
• Isometric exercises often are beneficial to maintain strength of the neck muscles.
•Neck and upper back stretching exercises,
•as well as light aerobic activities, also are recommended.
•Mechanical traction is a widely used technique. This form of treatment may be useful
because it promotes immobilization of the cervical region and widens the foraminal openings
•The exercise programs are best initiated and monitored by a physical therapist.
•Passive modalities generally involve the application of heat to the tissues in the
cervical region, either by means of superficial devices (e.g., Moist-heat packs) or mechanisms
for deep-heat transfer (e.g., ultrasound, diathermy).
➢Manual therapy (e.g., Massage, mobilization, manipulation may provide further relief for
patients with cervical spondylosis.
➢Mobilization is performed by a physical therapist and is characterized by the
application of gentle pressure within or at the limits of normal motion, with the goal
of increasing the ROM.
➢Manual traction may be better tolerated than mechanical traction in some ‫ر‬
patients.
➢Manipulation is characterized by a high-velocity thrust, which is often delivered at
or near the limit of the ROM. The intention is to increase articular mobility or realign
the spine.
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➢Contraindications to manipulative therapy include myelopathy, severe
degenerative changes, fracture or dislocation, infection, malignancy, ligamentous
` instability, and vertebrobasilar insufficiency.
• Unilateral stretching of the scalene muscles. The patient first performs

axial extension, then side-bends the neck opposite and rotates it toward
the tight muscles.
➢Stretching the short suboccipital muscles. The therapist

stabilizes the second cervical vertebra as the patient slowly
nods the head.
Traction
Surgical Intervention
➢Indications for surgery include the following:
➢(1) progressive neurologic deficits;
➢(2) documented compression of the cervical nerve root, spinal cord, or both;
➢(3)sever pain
• Approaches for surgery are anterior or posterior.

• Anterior approaches include the following: discectomy without bone graft,
discectomy with bone graft, and cervical instrumentation.
• Posterior approaches include the following: decompressive laminectomy and
foraminotomy, hemilaminectomy, and laminoplasty.
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CERVICAL SPONYLOSIS

Cervical spondylosis is a chronic degenerative condition of the

SIGNS AND SYMPTOMS

Mechanisms include direct nerve compression; degenerative disk, joint, or ligamentous

Causes of cervical spondylosis

MRI offers the following advantages:

• Unilateral stretching of the scalene muscles. The patient first performs

➢Stretching the short suboccipital muscles. The therapist

• Approaches for surgery are anterior or posterior.

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