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Cervical spondylosis
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🧠 Cervical spondylosis is a degenerative condition of the cervical spine, caused by age-related wear and tear of discs, vertebrae, and joints. It is extremely common - affecting up to 85% of adults over 60 - and is the most common cause of cervical myelopathy in the UK.
📖 About
- 💢 Leading cause of chronic neck pain in older adults.
- ⚡ Can cause radiculopathy (nerve root compression) and myelopathy (cord compression).
- 📍 Most commonly affects C5-6, C6-7, and C3-4 levels.
🔬 Aetiology
- ⏳ Disc Degeneration: Loss of hydration → reduced disc height → instability.
- 🦴 Osteophytes: Bone spurs form as stabilisation attempt, narrowing foramina/canal.
- ⚖️ Facet Hypertrophy: Enlarged joints contribute to canal narrowing.
- 📏 Ligament Thickening: Thickened ligamentum flavum compresses cord.
- 💥 Herniated Disc: Central → cord compression, lateral → radiculopathy.
🚨 Red Flag: Cervical canal narrowing below 13 mm risks cord compression. Symptoms of myelopathy (gait disturbance, hand clumsiness, bladder dysfunction) = urgent MRI & specialist referral.
🩺 Clinical Features
- 🧍♂️ Neck Pain & Stiffness - worsens with movement, limited ROM.
- ⚡ Radiculopathy: Dermatomal pain, numbness, tingling, weakness.
- 🧠 Myelopathy: Spasticity, gait ataxia, hyperreflexia, Babinski sign, bladder/bowel involvement in advanced cases.
- 🔊 Cervical Crepitus: “Grinding” with neck movement.
🧪 Investigations
- 🖥 MRI: Gold standard – shows cord compression, T2 hyperintensities (gliosis).
- 📡 X-Ray: Osteophytes, alignment, disc space narrowing.
- 🔍 CT: Excellent for bony detail (for surgical planning).
- ⚡ NCS/EMG: Helps distinguish radiculopathy from peripheral neuropathy.
💊 Management
- 🧘 Conservative: NSAIDs, physio, posture training, ergonomic modification.
- 💉 Interventional: Epidural steroids, facet joint injections, radiofrequency ablation.
- 🔪 Surgical: ACDF, laminectomy, foraminotomy, disc replacement for progressive neurological deficits.
📈 Prognosis
- 📌 Chronic but manageable with early intervention.
- 👍 Many improve with conservative therapy + lifestyle adaptation.
- ⚠️ Severe untreated myelopathy → irreversible deficits.
🛡 Prevention
- 🪑 Good posture & ergonomic setup.
- 🏋️ Regular exercise & neck strengthening.
- 🚭 Quit smoking → slows degeneration.
- ⚖️ Maintain healthy weight to reduce stress on spine.