CERVICAL SPONDYLOSIS

DR T.P MOJASTEVE BIKO ACADEMIC HOSPITAL

Pathophysiology Disc degeneration

-nucleus pulposus loses water content, fissuring, loss of height and bulging annulus.

-acute rupture and herniation may occur

Secondary changes due to increased and uneven loading of forces

- Vertebral osteophytes

- Facet and uncovertebral joint osteoarthritis and hypertrophy

- Ligamentum flavum becomes thickened and may ossify

- Spine deformity due to segmental instability

Degenerative spondylolistheses

Degenerative kyphosis or scoliosis

• Narrowing of the central canal, lateral recesses and foramina with subsequent neural and vascular compression

CERVICAL SPINE XRAY

MRI CERVICAL SPINE

Clinical PresentationAsymptomtic with incidental radiographic findings

Symptomatic - in most cases: onset is slow and insidious . However some cases may be acute eg hyperextension injury in minor trauma or acute disc herniation

Neck pain

Myelopathy

Radiculopathy

Neck pain• Occurs if there is a disc extrusion

• Nerve root compression

• Facet joint arthritis

• Segmental instability

• Often poorly localized

• May radiate to the occipital region, shoulders, interscapular.

• There may be associated stiffness of the neck from muscle spasm

Myelopathy• May be complex and variable

• Most cases seem to present with a central cord syndrome, rarely brown squard, or complete myelopathy

• Motor

• -upper limbs: LMN Weakness

•Clumsiness of the hands. Muscle wasting. Absent biceps reflex, inverted reflex, Triceps reflex may be brisk. Positive Hoffman reflex

• -Lower limbs: Spasticity, difficulty walking. No or slight weakness.

• Sphincters: usually no symptoms. Rarely mild bladder symptoms. ? Prostate

• Sensory

- No involvement

- Patchy sensory loss

- Paraesthesia in the hands, sometimes the feet and legs

- May be asymmetrical or symmetrical

- Different from radiculopathy in that it is not in a specific dermatomes

- Lhermittes’s sign

Radiculopathy•May be acute if due to a disc protrusion

•Slow and insidious if due to an osteophyte

•Most common nerve root is C6•Neck pain and shoulder pain. Pain radiates down the biceps, then the lateral aspect of the forearm then the thumb and index finger.

•Head may be tilted to the affected side due to muscle spasm. Pain made worse by neck extension, relieved by neck flexion and shoulder abduction.

•Often numbness, more often hand and fingers

• Chronic cases – wasting and fasciculations of biceps and brachioradialis muscle.

• Weakness of elbow flexion (Thumb-nose), and wrist extension.

• Absent biceps and brachioradialis reflex

C5 nerve root radiculopathy

• - Neck pain

• - Shoulder pain, pain over the lateral aspect of the upper arm.

• - Numbness or paraesthesia over the lateral aspect of the upper arm.

• - Weakness of deltoid and biceps muscles, with absent biceps reflex

•In severe cases, wasting of the deltoid and biceps muscles

TreatmentNeck Pain

-Conservative

-Rarely, surgery

Myelopathy

-Surgery in most cases

-Some may stabilize on conservative

Acute radiculopathy

-Conservative

-Surgery if indicated

Chronic radiculopathy

-Most cases, surgery

Conservative treatment• Medication: Analgesia

NSAIDS

Diazepam

Baclofen

Carbamazepine, Gabapentin, Lyrica

• Physiotherapy: Range of motion exercises

Isometric exercises

Heat and massage

• Traction: Continuous or intermittent halter traction

• Neck collar Soft neck collar < 1 week

• Facet and Medial branch block – Cortisone, L.A, Radiofrequency

SURGERY

• Anterior decompression– Anterior cervical discectomy and fusion– Corpectomy and fusion

• Posterior decompression– Laminaplasty– Laminectomy