Cervical Osteoarthritis

Cervical Osteoarthritis occurs when the protective cartilage in a spine joint begins to break down and leads to bone rubbing against bone which results in painful and stiff neck movements.

When the cartilage starts to wear away, bone starts rubbing against bone, which can facilitate excessive bone growth, known as bone spurs (osteophytes). Bone rubbing against bone can cause inflammation and pain. Furthermore, fragments of bone and cartilage might break off and start floating within the joint capsule’s synovial fluid, which can lead to more inflammation and discomfort.

Causes of Cervical Osteoarthritis

Cervical osteoarthritis becomes more common as people age, so the natural wear and tear over time is considered to be a major factor in its development. However other factors also appear to play a role in the development of osteoarthritis, including:

• Genetics. Some evidence suggests that osteoarthritis can run in families, which would indicate some people are genetically predisposed to having cartilage that breaks down sooner.

• Injury. If the joint becomes injured, such as a tear in the cartilage and/or protective joint capsule, the joint can become more inflamed and cartilage can wear down sooner. Joint injuries can happen in various ways, such as from a fall or while participating in a sport.

• Occupation. Certain occupations, such as jobs that involve lots of repetitive motions or heavy lifting like construction, can put more stress on the cervical spine.

• Weight. People who are overweight tend to develop osteoarthritis sooner, including in the neck.

• Smoking. Currently, the medical literature has limited data on whether or not smoking contributes to osteoarthritis in the spine. However, smoking has been linked to increasing neck pain in general.

Symptoms of Cervical Osteoarthritis

When cervical osteoarthritis becomes symptomatic, it is typically characterized by pain that:

• Starts gradually and may or may not get progressively worse over time

• Feels stiff and achy rather than sharp, especially in the early stages

• Is worse first thing in the morning, then improves after getting up and moving around

• Gets worse again at the end of the day

• Subsides with rest during a flare-up

• Radiates to the shoulder or between the shoulder blades

• Feels tender when the neck is pressed

• Disrupts sleep in the middle of the night

• Causes headaches, especially in the back of the head

A person with cervical osteoarthritis may experience all of these symptoms or only a few, and symptoms may progress or change over time.

Progression

Cervical bone spurs (osteophytes) are a common marker of cervical osteoarthritis. For some people with cervical osteoarthritis, these bony overgrowths may impinge on a spinal nerve, producing cervical radiculopathy symptoms of pain, tingling, numbness, and/or weakness that radiate down into the shoulder, arm, and/or hand.

If the osteoarthritis impinges on the spinal cord, it could lead to spinal cord dysfunction, called cervical myelopathy. This condition could include pain, tingling, numbness, and/or weakness anywhere in the body beneath the neck, as well as potential problems with coordination. For example, a person with cervical myelopathy could have trouble with walking, buttoning a shirt, or controlling bladder and bowel function.

In some instances, cervical spondylolisthesis (when one cervical vertebra slips forward over another) may be a secondary issue to the arthritis in the cervical facet joints, although spondylolisthesis is much more common in the lumbar spine (lower back).

Some conditions can feel similar to cervical osteoarthritis, so it is imperative to see a doctor for an accurate diagnosis and effective treatment plan.

When to seek immediate medical care

If cervical osteoarthritis becomes advanced and bone spurs become big enough, narrowing can start to occur in the spinal canal (spinal stenosis) and/or the intervertebral foramen (foraminal stenosis).

When these spaces start to narrow, the spinal cord or a cervical nerve root can become compressed. Some serious symptoms that could result include difficulty gripping objects or even problems with walking or coordination. If the spinal cord or a nerve root is compressed for long enough without seeking medical attention, permanent damage can occur.

Cervical osteoarthritis symptoms can range anywhere from an occasional mild discomfort to an unrelenting, severe pain that disrupts quality of life on a daily basis.

Initial Doctor Visit

In order to diagnose the cause of a patient’s neck pain, the doctor will likely start with the following:

• Review patient’s medical history. Many conditions can be ruled out simply by gathering a detailed list of the patient’s current symptoms, past medical history, and current lifestyle habits.

• Perform a physical exam. To further narrow down the list of possible neck pain causes, the doctor will palpate (feel) the patient’s neck for any abnormalities or tenderness, as well as test the neck for any noticeable weakness or reduced range of motion. If the patient has complained of symptoms radiating down the arm, the doctor will also likely perform Spurling’s test by gently applying pressure to the top of the head while bent to the side. Spurling’s test checks to see if compressing the cervical spine (temporarily) worsens or recreates the patient’s symptoms, which could indicate a pinched nerve.

Diagnostic Techniques

If the medical history and physical exam do not give the doctor enough information, or if the initial treatment plan is not providing relief, advanced diagnostics might be requested. This could include one or more of the following:

• X-ray. Using electromagnetic radiation, an X-ray (radiograph) of the spine can show good images of the bones and cartilage, and whether they are degenerating.

• MRI scan. Using radio waves and a strong magnet, an MRI creates a series of detailed cross-sections of soft tissues and bones. An MRI does not show bones as well as an x-ray, but the MRI is better at showing soft tissues and can be useful if nerve compression is suspected.

• Electrodiagnostic testing. Various tests can be done to check nerve function. Two tests commonly done together include an electromyography (EMG), which measures electrical activity in muscles, and a nerve conduction study, which measures how fast nerves are sending signals. A problem detected during electrodiagnostic testing could indicate a nerve in the neck is being compressed due to spinal degeneration.

This is not a complete list of advanced diagnostic techniques. Many other possibilities exist, including CT scan with myelogram.

Treatment

Treatment options for cervical osteoarthritis typically depend on the severity of symptoms and how often they disrupt daily life. Most often, nonsurgical treatment options will suffice for managing cervical osteoarthritis. In cases where pain worsens and various treatment methods have proven ineffective over a period of 6 to 12 weeks, surgery may be considered as a definitive resort.

Nonsurgical Treatment Options

If cervical osteoarthritis symptoms are mild, common treatments will include one or more of the following:

• Rest when symptoms flare. Sometimes limiting neck movements for a short while, such as for an afternoon or a day, is enough to let the inflammation go back down and pain dissipate.

• Cold and/or heat therapy. Some people prefer a cold pack, especially after an activity that results in pain, to minimize inflammation. Other patients prefer heat, such as a heating pad or heat wrap; or moist heat, such as a moist heat wrap for the neck or a warm bath or shower.

• Over-the-counter medications. Non-steroidal anti-inflammatory drugs (NSAIDs) may help relieve the pain from the inflammation that usually accompanies arthritis.

• Active lifestyle. Moderate exercise is good for the joints, including the neck’s facet joints. While rest is sometimes necessary during a painful flare-up, incorporating more movement into a daily routine oftentimes reduces long-term pain from cervical osteoarthritis. For example, committing to a walking regimen could be a good way to increase daily activity and naturally boost feel-good endorphins.

If cervical osteoarthritis symptoms are more moderate and persistent, other treatment options could include:

• Activity modification. Sometimes limiting or eliminating certain activities can prevent the worst of the flare-ups. For example, a person might find a specific swimming stroke twists the neck in a way that causes more pain than other swimming strokes. In that case, the problematic swimming stroke should be limited or completely avoided in the future. Everyone is different in terms of which activities might be more problematic for triggering cervical osteoarthritis symptoms.

• Physical therapy. A physical therapist or other medical professional can create a program of exercise and stretching that targets the patient’s specific needs. When the neck muscles become stronger and more flexible, they are less likely to spasm and cause pain.

Role of Surgery

While cervical osteoarthritis tends to be chronic, the symptoms sometimes progress enough to require surgery. For patients with severe symptoms that are impeding their ability to function, such as numbness or weakness that goes down into the arm or hand, surgery is the only option.

Two common surgical treatment options include:

• Anterior cervical discectomy and fusion (ACDF). A surgeon approaches through the front of the neck and removes the disc at the vertebral level where degenerative changes are causing severe symptoms. The disc is then replaced with a spacer that maintains enough height for cervical nerve roots to pass unimpeded, and the vertebral level is fused so no further motion should occur.

• Posterior cervical laminectomy. A surgeon approaches the cervical spine from the back of the neck and removes the back part of the vertebra (lamina and spinous process) to give more room and decompress the spinal cord. If spine stability is a concern, the laminectomy can be combined with a spinal fusion.