The spine is an important part of the skeleton and provides the necessary support and strength for the upper body. It also houses the spinal column which consists of the spinal cord, a long chain of nerve tissue, containing roots of hundreds of nerves. The spine can be divided into 3 portions –cervical spine in the neck, thoracic spine in the upper half of the torso and lumbar spine in the lower half of the torso.
The spine is made up of 24 large bones called vertebrae, joined by small bands of tissue called ligaments. The vertebrae are separated by discs which contain soft, gel-like material on the inside, and act as shock absorbers. The vertebrae are joined at the front (intervertebral disk joint) and at back (two facet joints). The joints contain cartilage which cushions the ends of the bones.
All of the above components of the spine are vulnerable to age-related wear and tear, creating a condition called Spondylosis. More specific to the cervical spine, the condition is called Cervical Spondylosis (CS), or Arthritis of the Neck.
Causes
With age, everybody undergoes wear and tear of the spine with almost 90% of the population showing a higher degree of the condition. The wear-and-tear manifests in different ways.
- Disk degeneration: The discs between the vertebrae become thinner and the soft gel-like tissue inside them starts dehydrating which shrinks the disc slightly.
- Herniated discs: The discs develop a crack and some of the tissue inside pushes outward, creating a bulge in the disc. The bulge presses on the nearby tissues or the spinal nerves.
- Osteoarthritis: While cartilage in the joints start degenerating with time for everybody, for people with osteoarthritis, this degeneration happens sooner and faster.
- Bone spurs: To make up for the age-related wear and tear, the spine tries to heal itself by creating small outgrowths of bone-tissue called bone spurs or osteophytes. These pinch the spinal cord and roots of the nerves.
- Ligament stiffness: The ligaments that connect the vertebrae lose their elasticity, making neck movements difficult and the neck feeling tight.
Risk Factors
While age is the primary cause for CS, there are several risk factors that can accelerate the onset of CS and worsen the symptoms:
- Overuse: Occupations where the person has to crane his/her neck upwards (construction supervisors and painters) or look down (plumbers, carpenters, garage mechanics and various technicians) or keep the neck in an awkward position, for several hours in a day, can trigger an early onset of CS. So also, occupations where there is repetitive neck motions (dancers), violent movements of the neck (gymnasts), lifting heavy loads (construction or logistics workers) and vibration of the body (vehicle drivers) put extra stress on the neck triggering CS early-on.
- Neck injuries: A vehicle accident, or a nasty fall can injure the cervical vertebrae or discs eventually triggering CS.
- Genes: In some families, members show more age-related wear and tear of the spine, even without the other risk factors being present.
- Smoking: In general, smoking reduces blood flow in the smaller arteries, triggering innumerable conditions in the body. Decreased blood flow to the cervical vertebrae and discs can trigger CS eventually.
- Being obese, and/or living a sedentary lifestyle: Reduced movements can weaken both bones and muscles eventually triggering CS
Symptoms
Early or moderate CS
- Neck pain or stiffness: This is the most common symptom. The pain is severe while moving the neck
- A soreness in the neck that doesn’t go away
- Muscle spasms, jerky movements or frozen neck
- Grinding, popping or clicking sound while moving the neck
- Pain around the shoulder blade that gets worse when standing, sitting, coughing, sneezing and tilting the head backwards
- Pain in the arms and fingers
Advanced or severe CS
As the condition progresses, the bone spurs pinch the spinal cord and nerves. Or the space where the spinal cord and nerves pass through get narrowed down, thereby squeezing the nerves. Specific nerves may get affected causing a host of conditions. This is when the person must certainly meet a doctor.
- Numbness or weakness in the hands, legs or feet
- Tingling sensation (‘pins and needles’) in the fingers and feet
- Poor muscle co-ordination and difficulty while walking
- Lack of bladder or bowel control
- Dizziness
- Headaches that occur at the back of the head
Diagnosis
An orthopedic doctor who specializes in spine-related ailments will run various tests on the person depending on his/her medical history, family medical history, risk factors in the person and stage of the condition.
Physical examination
- Assessing the range of motion in the neck
- Evaluating muscle strength and reflexes to check if there is pressure on the spinal cord or spinal nerves
- Watching the person’s walk and gait to check for spinal compression
Imaging tests
- Neck X-ray: This will reveal bone spurs, any abnormal growths of the spine and rule out other causes for neck-pain such as fractures, infections or tumors.
- CT scan: This will present a more vivid imagery of the bones.
- MRI scan: This will identify areas where the nerves are being pinched or squeezed
- Myelography: This will provide a more detailed imaging of the spinal cord and spinal nerves.
Nerve function tests
- Electrical activity in the nerves when the muscles are contracting and resting are measured
- Nerve conduction study: Nerves that are suspected to be affected will be studied. To do so, electrodes are attached to the skin just above those nerves and a small electric shock is passed through them to measure speed and strength of nerve signals.
Treatment
There are various treatment options depending on the stage and severity of the condition.
Physical therapy
- Exercise: A physiotherapist working closely with the orthopedic doctor will teach the patient exercises that strengthen muscles and improve posture.
- Heat and cold: A hot-pack or an ice-pack (either one, depending on what works for the patient) will be applied on the painful area, for 20 minutes, several times a day.
- Massage: An experienced masseur or physiotherapist will massage the neck taking adequate care to not aggravate the pain.
Medication
- Muscle relaxants: These drugs relieve muscle spasms in the neck.
- Anti-seizure medication: These will reduce the pain caused by damaged nerves
- Anti-depressants: These reduce sensation in the nerves, thereby reducing pain
- NSAIDs: Non-steroidal anti-inflammatory drugs help relieve the pain and inflammation caused by cervical spondylosis
- Corticosteroids: These are either given as oral medicines or injections to specific parts of the neck
Surgery
If none of the above works, or if the person is showing symptoms of advanced/severe CS, then surgery is the only option. Surgery may be done to achieve one or more of the following objectives.
- Removing a part of a vertebra that is damaged
- Removing a herniated disk entirely
- Removing one or more bone spurs or fusing two vertebrae using bone graft and hardware. This makes more room for the spinal cord.
Others
- Soft-collar or brace: For patients with early or moderate CS, a therapeutic collar can be used for a short time. This will limit the neck movement and help the muscles rest and recover.
- Media branch block and RF ablation: One or more spots are injected with an anesthetic. The spot where pain is relieved with anesthesia is identified as the area of nerve damage. Radio Frequency sound waves are then applied to this area, which help destroy those nerves causing the pain.
Complications
If CS is not diagnosed or treated on time, or in-spite of that – in some people, new complications arise.
- Spinal stenosis: The channel carrying the spinal cord and nerves narrow down, causing recurring and severe pain in the neck, back, arms and legs, along with tingling, numbness and weakness.
- Cervical radiculopathy: Changes happening in a disc or vertebra cause nerves in the spine to become squeezed, causing shooting pain, numbness, and hypersensitivity.
- Cervical spondylotic myelopathy: Here, the spinal cord becomes compressed showing symptoms as described above.
- Scoliosis: This is a side-ways curvature of the spine, which can be triggered by degeneration of the facet joints.
Outlook
As explained above, Cervical Spondylosis can develop into a serious condition that affects one’s mobility and quality of life. If you or your dear ones are showing any of the symptoms listed above, consult a spine-specialist at a reputed hospital. He/she will diagnose your condition and put you on the best course of treatment for quick recovery and rehabilitation.
Reviewed by Dr Suresh S Venkita, Group Medical Director, Kauvery Hospitals
Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.
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