A Family Doctor's Tale - CERVICAL SPONDYLOSIS

DOC I HAVE CERVICAL SPONDYLOSIS

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Cervical Spondylosis

One of my patient with severe cervical spondylosis has initially numbness of the right hand followed by weakness of the hand until he finally was unable to sign his name on a cheque. That was when he decided to go for treatment with neck collars and traction. He also gave up his job as head of a prison school. After treatment he was able to do most of the things prior to his severe condition. However as the years passed his condition deteriorated and he was unable to move his hands and legs as well as before. In the end he went for the operation which was a bit of disaster as infection cause his condition to become worse. However with aggressive antibiotic treatment and a strong will, he recovered some of his limb functions and is able to walk and do most things with some help from his wife.

Cervical Spondylosis is a degenerative disease of the joints of the cervical spine(neck), causing pain in the neck and nerve root irritation.


Every one can get Cervical Spondylosis.
The age of onset is usually in the late 40 or early 50's.
It is also more common in men than women.
It is worst in the lower cervical spine.


The causes of Cervical Spondylosis are:
1.Age Degeneration of the cervical spine due to usage such as bending the head to read or write. The weight of the skull serves to compress the vertebrae of the cervical spine as well as the intervertebral discs  which becomes worse with age.
2.Trauma and injury such as whip lash injury, head injuries can also indirectly injure the vertebra of the neck and cause intervertebral disc protrusions.
3. Congenital abnormality of the cervical spine such as incomplete formation of the vertebra and disc.


1.The onset is usually gradual with occasional neck pain over weeks or months.
2.There may be a history of trauma to the neck or prolonged neck strain.
3.Early morning neck stiffness and pain may occur,then wears off during the day.
4.The pain may radiate to the shoulder or upper limb. Pain can be persistent in some cases.
5. Numbness, paresthesia even weakness of the arm and hands may occur due to compression of the neck nerve root.
6.Headaches may be common due to pressure on the neck muscles giving rise to pain to the occipital region.
7.Neck movements may be restricted in all directions. There may be creaking sounds of the neck on movement.
8.Muscle weakness of the upper and/or lower limb with muscle wasting


Pain may be aggravated by stress, general health, prolonged period of the neck in one position.


Confirmation is usually by an xray of the cervical spine which may show:
Typical cervical vertebra degeneration,
Disc space narrowing
Osteophytic changes
Narrowing of the exit foramina
Subluxations of the vertebra
Sclerosis of the vertebral margins
Lordosis of the spine


Not every patient suffer the same degree of symptoms
1. mild requiring only exercises or mild pain killers.
2. more severe require:
a.Neck collars
b.physiotherapy -cervical traction, shortwave diathermy, neck exercises
c.NSAIDs painkillers
d.surgery for cord compression,intractable root symptoms,vertebral artery compression,weakness of arms or legs


3. All cases require:
protection of neck from muscle strain
avoidance of excessive bending and turning of neck
maintenance of good posture
avoidance of emotional stress


Symptoms comes and go.
With exercise and NSAIDS, pain is reduced and flexibility of the spine is improved especially with regular exercise and proper posture.
Injury and stress can aggravate the condition.
There is no cure.