Cervical Spondylosis

Cervical Spondylosis is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

Cervical spondylosis is degenerative joint disease (DJD) of the cervical spine. These degenerative changes in the intervertebral disks, vertebrae, facet joints, and ligamentous structures of the cervical spine are usually asymptomatic. In some cases, the hypertrophy and ossification of bony/soft tissues leads to narrowing of the neuroforaminal and/or cervical canal. Occasionally, this narrowing results in cervical nerve root (cervical spondylotic radiculopathy [CSR]) or spinal cord (cervical spondylotic myelopathy [CSM]) compromise.

  • Considered a natural process of aging; most people remain asymptomatic.
  • Symptomatic patients typically present with axial symptoms: neck, shoulder, and periscapular pain without neurologic symptoms.
  • Progression of cervical spondylosis to CSR and/or CSM is variable and difficult to predict.
  • Both radiculopathy and myelopathy can occur in the absence of axial symptoms.
  • System(s) affected: musculoskeletal; neurologic
  • Synonym(s): cervical degenerative joint/disk disease; cervical osteoarthritis; cervicalgia
Geriatric Considerations
  • Most individuals >65 years of age have evidence of cervical spondylosis on x-ray.
  • Consider myelopathy in elderly patients complaining of balance/gait disturbance or bilateral pain/weakness of the upper and/or lower extremities.
Pediatric Considerations
  • Radiographic changes can be seen when patients achieve skeletal maturity. Younger patients are more likely to present due to an acute disk herniation.
  • Congenital spinal stenosis predisposes to early onset of symptoms especially after minor trauma.

Epidemiology

Incidence
Predominant sex: male > female (3:2 ratio) (1,2)

Prevalence
  • 10% by age 25 years
  • 95% by age 65 years

Etiology and Pathophysiology

  • Disk desiccation leads to loss of disk height and biomechanical changes in the spine.
  • Spinal ligaments and annular fibers weaken, shifting the load to the dorsal vertebral column.
  • Altered load balance results in loss of cervical lordosis and overloading of the uncovertebral and facet joints, triggering osteophyte formation; bony and ligamentous hypertrophy and ossification
  • Load transfer to adjacent spinal levels contributes to cervical kyphosis.
    • The most common level of disk degeneration is C5–C6 and C6–C7.
    • The most common level of facet degeneration is C2–C3.

Genetics
Genetic predisposition has been described (1,2,3).

Risk Factors

  • Age
  • Previous cervical spine trauma (1)
  • Smoking
  • Congenital anomalies of the cervical spine (2)
  • Dystonic cerebral palsy (2)

Commonly Associated Conditions

  • Arthritis, spinal stenosis, radiculopathy, myelopathy, and cervical spine injury
  • 10–15% of patients have coexisting lumbar stenosis.
  • Ossification of the posterior longitudinal ligament

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